Instruction to parents for bowel preparation before colonoscopy in children (Dr Sabya)

PEDIATRIC COLONOSCOPY: BOWEL PREPARATION INSTRUCTION

(Photograph_1: Myself performing an upper GI Endoscopy procedure)

Proper bowel preparation prior to colonoscopy is VERY IMPORTANT. If your child’s bowels (small intestine and large intestine) are not cleaned out well enough, the procedure may have to be canceled or rescheduled for a later date. If you are unable to follow the instructions or have any questions, please reach out to your doctor or health care nurse.

2-3 days prior to the procedure:  Give the child a liquid or semisolid diet (milk, dal, fruit juice, soup or broth, khichri, dahlia) from 2-3 days prior to the procedure. Try to avoid solid food as it might be difficult to clear out with laxatives and interfere with the visibility of the gut for which the procedure is intended to be done primarily.

On the day before the procedure: Prepare PEGLEC solution [Polyethylene glycol with electrolytes for oral solution (137.15g); mix the whole packet with 2 liters of drinking water; Additional flavor (pineapple or orange) available within the packet can be added for taste] for a demo video (on how to prepare PEGLEC solution): https://youtu.be/iuVuYcraiCU (Picture_2: a PEGLEC sachet, commonly used laxative for bowel cleaning prior to colonoscopy) Administer the PEGLEC solution orally from 1 pm onwards;  Give 250 ml orally every hour (for infants: 30 ml/kg/hour);  it will result in frequent defecation with loose stools, may be up to 10-15 times in next few hours; Continue giving it till stool becomes clear and watery. In some older children and adolescents, it might be necessary to give up to 3-4 liters of the solution (i.e. more than one packet of PEGLEC might be needed).  However, normal water can be given in between to maintain the hydration and to alter the taste.  Mild side effects like nausea, abdominal pain or colic can occur which usually don’t need any medical intervention or stoppage of therapy.  However, if the pain is severe or associated with abdominal swelling with multiple vomiting episodes, it is better to discontinue the solution and inform your healthcare nurse beforehand.  If the child is having persistent vomiting or there is a history of failed procedure because of poor bowel preparation, the child might need to be admitted to daycare one day prior for bowel preparation with an NG (naso-gastric) tube.

On the day of Colonoscopy: Keep the NPO (nothing per oral) in the morning.  [If your child is taking prescribed medications, they can usually be continued with just a sip of water] Time: Try to reach well ON TIME. The admission procedure begins at 8 am in the morning. (this time varies as per the institution policy and physician’s time-slot).  Venue: To the endoscopy room of the hospital.  (Picture_3: schematic diagram showing how the the colonoscope  is passed into the bowel from rectum in side lying position  and real time video is seen in monitor)

After Arrival to endoscopy centre: Report checking  [ CBC, Viral markers (HBsAg, Anti-HCV, Anti-HIV I & II), Coagulation profile, if needed]  Informed consent form to be signed by the attendants or parents so as to consent for the procedure after being aware of the possible complications, though minor and mostly non-life threatening, of this procedure. (complications are usually none, however mild drowsiness and lethargy due to sedative drug effect for few hours, mild abdominal pain or discomfort for few days, mild bleeding due to inadvertent trauma to the delicate mucosa can occur in few cases) Admission slip to be made from Railway counter (the monetary amount to be deposited at the counter) Intravenous (IV) cannulation: usually for infants and smaller children to give intravenous sedation before and during the procedure.  IV fluid: may be given to infants and smaller children to alleviate the risk of dehydration. Dress changing: disposable gown will be provided from the procedure room. Child’s clothes are to be taken off and kept with attendants.  Loose (Lactulose) enema will be given per-rectally to clear out the last part of bowel like rectum and sigmoid colon for a better visibility.  Child will be taken to the endoscopy room for sedation followed by the procedure. (older children and adolescents might not require sedation if the procedure is only for rectum and sigmoid colon …i.e Procto-sigmoidoscopy). Vital signs (like heart rate, oxygen saturation) will be monitored throughout the procedure.  The procedure usually takes 30-40 min to complete, however it might take longer depending upon the bowel preparation, nature and extent of disease, and technical difficulties.  After the procedure, the child will be shifted out of the endoscopy room for observation and monitoring for a few hours. Unless any severe complications, which are very rare, the child will be discharged shortly in 3-4 hours after the procedure is over.  Report: the report is usually given on the same day and will be explained by your doctor. In many cases, mucosal biopsies are taken which are sent for histopathological examinations in the department of Pathology. The biopsy report might take up to one week to be reported. The further course of action will be guided by your child's physician.  After discharge, you can start a normal diet again for the child. However, as the bowel might have some minute inflammation due to scope trauma, it is advisable to continue a semi solid diet for a day or two.  For any query regarding the procedure, complications or further management options, it is better to discuss with the physician.

(Picture_4: a prototype of colonoscopy report; this is just for a demonstration of how a report looks like; findings vary from patient to patient)

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