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Russo G, Alvisi P, Romano C, Angelino G, Lemale J, Lachaux A, Lionetti P, Veereman G, Ruggiero C, Padovani M, Tacchi R, Cenci F, Cucchiara S, Oliva S. Efficacy and safety of a new low-volume PEG with citrate and simethicone bowel preparation for pediatric elective colonoscopy: Phase 3 RCT. Endosc Int Open 2024; 12:E629-E638. [PMID: 38681144 PMCID: PMC11052644 DOI: 10.1055/a-2251-3372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/17/2024] [Indexed: 05/01/2024] Open
Abstract
Background and study aims Currently available polyethylene glycol (PEG)-based preparations continue to represent a challenge in children. The aim of this study was to compare the efficacy and safety of a new low-volume PEG preparation with a conventional PEG-electrolyte solution (PEG-ES) in children and adolescents. Patients and methods This was a multicenter, randomized, observer-blind, parallel-group, phase 3 clinical trial, where patients were randomized between PMF104 (Clensia) and a conventional PEG-ES (Klean-Prep), and stratified by age stratum (2 to <6; 6 to < 12;12 to <18 years). The primary endpoint was to test the non-inferiority of PMF104 versus PEG-ES, in terms of colon cleansing. Safety, tolerability, acceptability, palatability, and compliance were also assessed. Efficacy endpoints were analyzed in the per protocol set (PPS) and full analysis set (FAS) and safety and tolerability endpoints in the safety set (SAF). Results Of the 356 patients enrolled, 258 were included in the PPS, 346 in the FAS, and 351 in the SAF. Non-inferiority of PMF104 was confirmed for children aged > 6 years and for all age groups in PPS and FAS, respectively. Optimal compliance was reported more frequently in the PMF104 than in the PEG-ES group, in both PPS (86.1% vs. 68.4%) and FAS (82.9% vs. 65.3%). Both preparations were equally safe and tolerable. Palatability and acceptability were considered better in the PMF104 group than in the PEG-ES group (27.1% vs. 15.3% and 15.3% vs. 3.5%, respectively). Conclusions In children aged 6 to 17 years, the new low-volume product PMF104 is non-inferior to the reference PEG-ES in terms of bowel cleansing, safety, and tolerability, with slightly better results in compliance, palatability, and acceptability.
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Affiliation(s)
- Giusy Russo
- Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Sapienza University of Rome, Rome, Italy
| | - Patrizia Alvisi
- Department of Paediatrics, Ospedale Maggiore, Local Health Authority, Ospedale Maggiore di Bologna, Bologna, Italy
| | - Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Giulia Angelino
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Rome, Italy
| | - Julie Lemale
- Department of Pediatric Nutrition and Gastroenterology, Armand-Trousseau Childrens Hospital, Paris, France
| | - Alain Lachaux
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Lyon, BRON, France
| | - Paolo Lionetti
- Pediatric Gastroenterology and Nutrition Unit, Meyer Children's Hospital, Florence, Italy
| | - Genevieve Veereman
- Department of Pediatric Gastroenterology and Nutrition, University Hospital Brussels, Brussels, Belgium
| | - Cosimo Ruggiero
- Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Sapienza University of Rome, Rome, Italy
| | | | | | - Fabio Cenci
- Corporate R&D Department, Alfasigma SpA, Bologna, Italy
| | - Salvatore Cucchiara
- Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Sapienza University of Rome, Rome, Italy
| | - Salvatore Oliva
- Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Sapienza University of Rome, Rome, Italy
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Mahoney LB, Walsh CM, Lightdale JR. Promoting Research that Supports High-Quality Gastrointestinal Endoscopy in Children. Curr Gastroenterol Rep 2023; 25:333-343. [PMID: 37782450 DOI: 10.1007/s11894-023-00897-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE OF REVIEW Defining and measuring the quality of endoscopic care is a key component of performing gastrointestinal endoscopy in children. The purpose of this review is to discuss quality metrics for pediatric gastrointestinal endoscopy and identify where additional research is needed. RECENT FINDINGS Pediatric-specific standards and indicators were recently defined by the international Pediatric Endoscopy Quality Improvement Network (PEnQuIN) working group through a rigorous guideline consensus process. Although the aim of these guidelines is to facilitate best practices for safe and high-quality gastrointestinal endoscopy in children, they highlight the pressing need to expand upon the body of evidence supporting these standards and indicators as predictors of clinically relevant outcomes. In this review, we propose and discuss ideas for several high-yield research topics to engage pediatric endoscopists and promote best practices in pediatric endoscopy.
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Affiliation(s)
- Lisa B Mahoney
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jenifer R Lightdale
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.
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Huang JS, Walsh CM. Electronic Medical Records: Use as Tools for Improving Quality in Pediatric Endoscopy. Gastrointest Endosc Clin N Am 2023; 33:267-290. [PMID: 36948746 DOI: 10.1016/j.giec.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Quality indicators and standards for pediatric endoscopy have recently been developed by the inaugural working group of the international Pediatric Endoscopy Quality Improvement Network (PEnQuIN). Currently available electronic medical record (EMR) functionalities can enable real-time capture of quality indicators to support continuous quality measurement and improvement within pediatric endoscopy facilities. Ultimately, EMR interoperability and cross-institutional data sharing can serve to validate PEnQuIN standards of care and permit benchmarking across endoscopy services, in the pursuit of elevating the quality of endoscopic care for children everywhere.
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Affiliation(s)
- Jeannie S Huang
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, MC 0984, La Jolla, CA 92093, USA; Division of Pediatric Gastroenterology, Rady Children's Hospital San Diego, 3020 Children's Way, San Diego, CA, USA.
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology, and Nutrition, and the SickKids Research and Learning Institutes, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics and The Wilson Centre, University of Toronto, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Poddar U, Vadlapudi SS. What Is the Best for Colon Preparation: Single-Dose, Split-Dose or Add-ons to Polyethylene Glycol? Indian Pediatr 2022. [DOI: 10.1007/s13312-021-2389-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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