Skills and experience have advanced to the point that both diagnostic and therapeutic colonoscopies are now routinely performed by most pediatric gastroenterologists. The available equipment permits examination of all pediatric patients including neonates. Successful completion including ileal intubation is a technical challenge among all pediatric patients. An additional level of complexity in pediatric patients is the poor compliance with the necessary bowel cleansing and the difficulties in sedating a frightened or otherwise uncooperative patient.
Pre-procedural preparation should be individualized according to the child’s age, cooperation of the child and the individual experience of the specific center. In infants, adequate preparation can usually be obtained with the use of small-volume enemas and by substituting clear liquids for milk 12 to 24 hours prior to the procedure. Since there is no ideal bowel cleansing regimen in children, various protocols have been compared by Turner et al. Several evidence-based protocols were proposed to optimize preparation and minimize adverse effects [27]. The acute toxicity rate of oral sodium phosphate was estimated to be at most 3/7,320 colonoscopies (0.041%). The safety and effectiveness of large polyethylene glycol-based solutions with electrolytes (PEG-ES), causing osmotic diarrhea, has been demonstrated. Nevertheless, taste and volume might be barriers to efficient colonoscopy preparation. In the combination of polyethylene glycol 3350 with a sports drink nausea/ vomiting were the most reported side effects followed by abdominal pain/cramping and fatigue/weakness [28,29]. Continuous application via a nasogastric tube might improve tolerability in some of the children. Recently, the safety and efficacy of a two-day small volume electrolyte-free preparation (PEG-P) has been reported, which, additionally, was well tolerated and might improve compliance in the near future [30].