Picoprep Split-dose Before Colonoscopy in Children

NCT04767633 | Unknown Phase 3

• 1 other identifier: PICOPREP-SPLIT v.1 02/09/2020
• Study Type: interventional
• Target: 590
• Locations: 0 countries
• Sites: N/A

Brief Summary

Before having a colonoscopy, it is necessary to clean the intestine well in order to have a complete view of the intestinal mucosa. Preparations consisting of osmotic agents are used to clean the intestines, which are sometimes difficult to drink. In this study we want to evaluate whether the preparation, based on sodium picosulfate plus magnesium citrate (PMC), is easier for the patient to take all day before the exam or half the day before and half the same morning of procedure and which method of intake allows the doctor to better conduct the examination. The primary objective of this study will be to compare the efficacy, tolerability and acceptability of two dosage regimens of sodium picosulfate plus magnesium citrate (PMC). Effectiveness means which of the two methods of taking the preparation works best for cleaning the intestine, with tolerability if one of the two methods is easier for the patient and with acceptability if one of the two methods is easier than the other.

Conditions

Sodium Picosulfate Overdose; Magnesium Sulfate Overdose; Children, Only; Bowel Disease

Outcome Measures

Primary Outcomes (1)

• Best Colonic Cleansing in 590 pediatric patient underwent colonoscopy

  Primary outcome will be the overall colon cleansing defined as the rate of successful cleansing (excellent and good scores in the BBPS, i.e. ≥ 6 points) of the two preparation regimen.

  18 months

Secondary Outcomes (5)

• the rate of adverse events

  18 months

• the rate of specific symptoms associated to colonic lavage solutions

  18 months

• the rate of children who declared that they would be willing to repeat the same preparation regimen if needed

  18 months

• the rate of children who declared that the intake of the solution was easy

  18 months

• the rate of children taking an amount of solution ≥ 75%

  18 months

Study Arms (2)

group A (PMC standard-dose)

ACTIVE COMPARATOR

Group A (PMC standard-dose): patients will receive two oral doses of sodium picosulphate plus magnesium oxide and citric acid (Picoprep), each diluted in 150 ml of water, at 17:00 and 4 hours later in the evening prior to the colonoscopy (¼ sachet for children \< 6 years, ½ sachet for children 6-12 years, and one sachet for children \>12 years). Intake of at least 40-50 ml/kg (maximum 2 L) of clear fluids (cold tea, gatorade etc..) will be recommended after each dose. The age-adjusted dosage is dictated by the instructions of the manufacturing company. No solid food intake will be allowed during the 24 hours prior to the examination according to the instructions of the manufacturing company.

Drug: split dose vs standard dose of sodium pico sulfate plus magnesium sulfate in children for bowel cleansing

Group B (PMC split-dose)

ACTIVE COMPARATOR

Group B (PMC split-dose): patients will receive the first oral doses of PMC diluted in 150 ml of water (Picoprep; Ferring Italia, Milan, Italy) at 19:00 of the day before colonoscopy and the second one at 06:00 hours on the morning of the day of colonoscopy (¼ sachet for children \< 6 years, ½ sachet for children 6-12 years, and one sachet for children \>12 years). Intake of at least 40-50 ml/kg (maximum 2 L) of clear fluids (cold tea, gatorade etc..) will be recommended after each dose. The age-adjusted dosage is dictated by the instructions of the manufacturing company. No solid food intake will be allowed during the 24 hours prior to the examination according to the instructions of the manufacturing company.

Drug: split dose vs standard dose of sodium pico sulfate plus magnesium sulfate in children for bowel cleansing

Interventions

split dose vs standard dose of sodium pico sulfate plus magnesium sulfate in children for bowel cleansing DRUG

The preparations will be dispensed by a nurse who carefully explained how the products should be taken, emphasising the importance of complete intake of the solution to ensure a safe and effective procedure. Moreover, each patient will be provided with dietary instructions: low residue diet for 3 days before colonoscopy. During and after bowel preparation, solid food will not be allowed. Clear liquid could be taken until 2 hours before the procedure. All colonoscopy will be performed between 11:00 and 15:00 by two endoscopists.

Group B (PMC split-dose); group A (PMC standard-dose)

Eligibility Criteria

• Age: 2 Years - 18 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64)

You may qualify if:

• children aged 2-18 years undergoing elective colonoscopy

You may not qualify if:

• requirement for urgent colonoscopy
• bowel obstruction,
• known or suspected hypersensitivity to the active or other ingredients
• clinically significant electrolyte imbalance
• prior intestinal resection
• known metabolic, renal and cardiac disease.

Sponsors & Collaborators

• Azienda Ospedaliera "Sant'Andrea": lead

Related Publications (14)

• ASGE Standards of Practice Committee; Lightdale JR, Acosta R, Shergill AK, Chandrasekhara V, Chathadi K, Early D, Evans JA, Fanelli RD, Fisher DA, Fonkalsrud L, Hwang JH, Kashab M, Muthusamy VR, Pasha S, Saltzman JR, Cash BD; American Society for Gastrointestinal Endoscopy. Modifications in endoscopic practice for pediatric patients. Gastrointest Endosc. 2014 May;79(5):699-710. doi: 10.1016/j.gie.2013.08.014. Epub 2014 Mar 1.

  PMID: 24593951 BACKGROUND

• Froehlich F, Wietlisbach V, Gonvers JJ, Burnand B, Vader JP. Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European Panel of Appropriateness of Gastrointestinal Endoscopy European multicenter study. Gastrointest Endosc. 2005 Mar;61(3):378-84. doi: 10.1016/s0016-5107(04)02776-2.

  PMID: 15758907 BACKGROUND

• Belsey J, Epstein O, Heresbach D. Systematic review: oral bowel preparation for colonoscopy. Aliment Pharmacol Ther. 2007 Feb 15;25(4):373-84. doi: 10.1111/j.1365-2036.2006.03212.x.

  PMID: 17269992 BACKGROUND

• Barkun A, Chiba N, Enns R, Marcon M, Natsheh S, Pham C, Sadowski D, Vanner S. Commonly used preparations for colonoscopy: efficacy, tolerability, and safety--a Canadian Association of Gastroenterology position paper. Can J Gastroenterol. 2006 Nov;20(11):699-710. doi: 10.1155/2006/915368.

  PMID: 17111052 BACKGROUND

• Dahshan A, Lin CH, Peters J, Thomas R, Tolia V. A randomized, prospective study to evaluate the efficacy and acceptance of three bowel preparations for colonoscopy in children. Am J Gastroenterol. 1999 Dec;94(12):3497-501. doi: 10.1111/j.1572-0241.1999.01613.x.

  PMID: 10606310 BACKGROUND

• Hunter A, Mamula P. Bowel preparation for pediatric colonoscopy procedures. J Pediatr Gastroenterol Nutr. 2010 Sep;51(3):254-61. doi: 10.1097/MPG.0b013e3181eb6a1c.

  PMID: 20683200 BACKGROUND

• Pall H, Zacur GM, Kramer RE, Lirio RA, Manfredi M, Shah M, Stephen TC, Tucker N, Gibbons TE, Sahn B, McOmber M, Friedlander J, Quiros JA, Fishman DS, Mamula P. Bowel preparation for pediatric colonoscopy: report of the NASPGHAN endoscopy and procedures committee. J Pediatr Gastroenterol Nutr. 2014 Sep;59(3):409-16. doi: 10.1097/MPG.0000000000000447.

  PMID: 24897169 BACKGROUND

• Hassan C, East J, Radaelli F, Spada C, Benamouzig R, Bisschops R, Bretthauer M, Dekker E, Dinis-Ribeiro M, Ferlitsch M, Fuccio L, Awadie H, Gralnek I, Jover R, Kaminski MF, Pellise M, Triantafyllou K, Vanella G, Mangas-Sanjuan C, Frazzoni L, Van Hooft JE, Dumonceau JM. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2019. Endoscopy. 2019 Aug;51(8):775-794. doi: 10.1055/a-0959-0505. Epub 2019 Jul 11.

  PMID: 31295746 BACKGROUND

• Tripathi PR, Poddar U, Yachha SK, Sarma MS, Srivastava A. Efficacy of Single- Versus Split-dose Polyethylene Glycol for Colonic Preparation in Children: A Randomized Control Study. J Pediatr Gastroenterol Nutr. 2020 Jan;70(1):e1-e6. doi: 10.1097/MPG.0000000000002511.

  PMID: 31567887 BACKGROUND

• Sriphongphankul H, Tanpowpong P, Lertudomphonwanit C, Treepongkaruna S. Split dose versus full single-dose regimen of polyethylene glycol for bowel preparation in pediatric colonoscopy: a pilot study of randomized controlled trial. Eur J Gastroenterol Hepatol. 2019 Nov;31(11):1382-1386. doi: 10.1097/MEG.0000000000001562.

  PMID: 31567637 BACKGROUND

• Martel M, Barkun AN, Menard C, Restellini S, Kherad O, Vanasse A. Split-Dose Preparations Are Superior to Day-Before Bowel Cleansing Regimens: A Meta-analysis. Gastroenterology. 2015 Jul;149(1):79-88. doi: 10.1053/j.gastro.2015.04.004. Epub 2015 Apr 8.

  PMID: 25863216 BACKGROUND

• Di Nardo G, Aloi M, Cucchiara S, Spada C, Hassan C, Civitelli F, Nuti F, Ziparo C, Pession A, Lima M, La Torre G, Oliva S. Bowel preparations for colonoscopy: an RCT. Pediatrics. 2014 Aug;134(2):249-56. doi: 10.1542/peds.2014-0131. Epub 2014 Jul 7.

  PMID: 25002661 BACKGROUND

• Lai EJ, Calderwood AH, Doros G, Fix OK, Jacobson BC. The Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research. Gastrointest Endosc. 2009 Mar;69(3 Pt 2):620-5. doi: 10.1016/j.gie.2008.05.057. Epub 2009 Jan 10.

  PMID: 19136102 BACKGROUND

• Manes G, Repici A, Hassan C; MAGIC-P study group. Randomized controlled trial comparing efficacy and acceptability of split- and standard-dose sodium picosulfate plus magnesium citrate for bowel cleansing prior to colonoscopy. Endoscopy. 2014 Aug;46(8):662-9. doi: 10.1055/s-0034-1365800. Epub 2014 Jul 14.

  PMID: 25019969 BACKGROUND

MeSH Terms

Conditions

Intestinal Diseases

Interventions

Magnesium Sulfate

Condition Hierarchy (Ancestors)

Gastrointestinal Diseases; Digestive System Diseases

Intervention Hierarchy (Ancestors)

Magnesium Compounds; Inorganic Chemicals; Sulfates; Sulfuric Acids; Sulfur Acids; Sulfur Compounds

Study Officials

• Enrico Felici, DR

  Azienda Ospedaliera SS. Antonio e Biagio e C. Arrigo - Alessandria

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Enrico Felici, DR

CONTACT

0039 0131206764; enrico.felici@ospedale.al.it

Study Design

• Study Type: interventional
• Phase: phase 3
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, INVESTIGATOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Head of Pediatric Unit

Study Record Dates

• First Submitted: December 29, 2020
• First Posted: February 23, 2021
• Study Start: April 1, 2021
• Primary Completion: April 16, 2022
• Study Completion: July 16, 2022
• Last Updated: February 23, 2021

Record last verified: 2021-02

Data Sharing

• IPD Sharing: Will not share