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197 Colonic manometry and contrast enemas 9 Colonic manometry Our center's colonic manometry protocol is briefly summarized. Children were admitted to the hospital one day prior to the manometry study for colonic lavage with high-dose polyethylene glycol with electrolytes (GoLYTELY ® ) via a nasogastric tube, other motility influencing agents were stopped before the colonic manometry. Children received a clear liquid diet starting 24 hours prior to placement of the catheter and fasted overnight. On the next day, the manometry catheter was placed under general anesthesia with the aid of colonoscopy or under fluoroscopic guidance by an interventional radiologist. If placed with colonoscopy, the tip of the catheter was clipped to the mucosa using hemostatic clips to secure the position of the catheter. Recordings lasted five hours or longer; two hours before and two hours after a meal, followed by at least one hour of recording after intraluminal administration of bisacodyl (~0.2 mg/kg) through the central lumen of the catheter. If this initial dose of bisacodyl did not induce adequate response as determined by number and quality of HAPCs, an additional dose of bisacodyl was administered. Before administration of bisacodyl and following the postprandial observation period, the placement of the catheter was confirmed with an abdominal X-ray. All recordings were performed with a solid-state catheter with 36 sensors (spaced 3 cm apart) or a water-perfused catheter with eight channels (spaced 10 cm or 15 cm apart). Colonic manometry was recorded with Solar GI colonic manometry software (MMS, Enschede, the Netherlands, stationary manometry version 9.3K). All recordings were manually examined for the presence of HAPCs by one of the authors (I.J.N.K). HAPCs were defined as pressure sequences with a peak amplitude of ≥75 mm Hg that migrated in an antegrade direction over ≥15 cm. 19 The length of propagation of these HAPCs was evaluated. Based on the colonic manometry recording in combination with the abdominal X-ray, we determined the distance (in cm) from the anal verge where HAPCs terminated. The sensor where HAPCs were no longer visible in the manometry recording was defined as the point of termination. If multiple HAPCs were present, the most distally propagating HAPC was used, regardless whether this HAPC occurred spontaneously or after administration of bisacodyl. A previous study has shown that bisacodyl-induced HAPCs are similar in amplitude, duration, propagation velocity, and sites of origin and extinction to spontaneous HAPCs. 20 HAPCs which terminated >15 cm from the anal verge were categorized as prematurely terminating HAPCs.