Bowel Preparation Outcomes Using Low‐Volume Polyethylene Glycol With Selective Rescue Enema in Pediatric Colonoscopy

BACKGROUND: Bowel preparation for pediatric colonoscopy is challenging owing to poor tolerance of high-volume polyethylene glycol (PEG). We investigated bowel preparation quality using reduced-volume PEG and the clinical utility of rescue enemas for incomplete PEG ingestion in children. METHODS: We retrospectively reviewed 158 patients (≤ 15 years) undergoing colonoscopy after oral PEG preparation (2014-2025). Demographics, PEG volume, vomiting, taste intolerance, and enema use were analyzed. Bowel cleanliness was assessed using the Boston (BBPS) and Ottawa Bowel Preparation Scales (OBPS). RESULTS: Median age was 13.0 years and median body weight was 42.1 kg. The median PEG dose was 37.9 mL/kg (below standard recommendations). The cleansing adequacy rate (BBPS ≥ 6) was 98.1% (median BBPS: 9.0; OBPS: 0.0). Vomiting and taste intolerance occurred in 11.4% and 42.4% of patients, respectively. Rescue enemas, required in 48.7% of patients, safely maintained adequate cleansing despite incomplete PEG ingestion. Younger age (odds ratio [OR]: 0.84; 95% CI: 0.73-0.98; p = 0.022) and taste intolerance (OR: 4.14; 95% CI: 1.34-12.8; p = 0.014) were significantly associated with vomiting. CONCLUSIONS: Low-volume PEG was associated with adequate bowel cleansing. Rescue enemas are practical adjuncts for incomplete PEG intake. Because younger age and taste intolerance increase vomiting risk, optimizing PEG tolerability and incorporating rescue measures are essential for pediatric bowel preparation.