Abstract
BACKGROUND: Adequate bowel preparation is critical for the success of pediatric colonoscopy. International guidelines recommend standardized low-volume regimens, although several studies also support individualized, patient-tailored approaches. Despite this, real-world pediatric practices remain highly heterogeneous. This national survey aimed to investigate current bowel preparation practices for pediatric colonoscopy in Italy and compare them with international recommendations. METHODS: A nationwide electronic survey was conducted among centers affiliated with the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP). The questionnaire explored bowel preparation protocols, adherence to international guidelines, and the occurrence of adverse events. RESULTS: A total of 39 centers participated in the survey. Sodium picosulfate and polyethylene glycol with electrolytes were the most commonly used preparation agents, although high-volume solutions are often poorly tolerated. Only 43.6% of centers adhered to international guidelines recommending low-volume regimens, whereas 12 centers (30.8%) adopted multiple preparation strategies tailored to clinical indications and patient-specific characteristics. Preparation setting (home vs. hospital), agent selection, and use of enemas or laxatives varied significantly. Adverse events were uncommon, and most centers considered bowel preparation stressful for children. The Boston Bowel Preparation Scale was the most commonly used tool for assessing bowel cleanliness. Nearly all clinicians expressed a strong need for national pediatric guidelines. CONCLUSIONS: This survey, conducted by SIGENP, reveals substantial variability in bowel preparation practices for pediatric colonoscopy across Italian centers, reflecting a trend also observed in other countries. Our results underscore the urgency of developing and implementing pediatric bowel preparation guidelines to ensure safety, improve tolerability, and reduce heterogeneity of practice. Further research is needed to assess whether such variability may offer benefits through individualized approaches tailored to the specific needs of each child. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13052-026-02227-4.