It is felt that preparing the child with polyethylene glycol (PEG) on the day of colonoscopy is sufficient(1). However, we believe, that liquid diet and high bowel wash, a day prior to the procedure with oral electrolyte lavage solution (PEG) improves the bowel preparation considerably and helps in better visualization of bowel mucosa. Moreover, the absence of liquid stools at the site of polyp facilitates the polypectomy procedure . safely. The preparation, a day prior to the procedure is well tolerated by the children and the precaution is taken to prevent water-electrolyte imbalance by continuous monitoring and keeping the child hydrated. The inconvenience to parents and child because of frequent motions, is seen, albeit, very rarely. We reconstitute PEG solution by dissolving one packet in two liters of water and asking the child to gulp half the amount. Alternatively, half the packet is dissolved in one litre of water. We compliment the authors for pointing out the error in the text.

In accordance with the other authors(2), we agree that ketamine is the safe agent for sedation during pediatric procedures. In fact, the practice is to use ketamine for colonoscopic polypectomy at our center. Ketamine was made available in the recent few years and obviously few children required general anesthesia for polypectomy during earlier years. Poddar et al. have pointed out that juvenile polyposis is more frequently found thanadenomatous polyposis in children(3). Contrary to that and to our surprise juvenile polyposis was not found in our series. In fact, we had reviewed our slides again by an experienced histopathologist in a patient with multiple polyps and there were no hamartomatous changes in any of the retrieved polyps. Whether it was a true adenomatous polyposis or adenomatous changes completely replacing the juvenile polyposis is a matter of debate. Solitary jevenile polyp has to be removed, whether symptomatic or asymptomatic. However, all children referred to us were symptomatic and presented to us with bleeding per rectum, hematochezia or colicky pain. Asymptomatic juvenile polyp is rarely ever diagnosed in clinical practice, unless screening is done. We would advise our readers to read this finding in this clinical context.
 

Pravin Rathi,
Prabha Sawant,
Department of Gastroenterology,
 L.T.M. Medical College and
L T.M. General Hospital,
Sion, Mumbai 400 022,
India.