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Colonic inflammation found at diagnosis of juvenile retention polyps in pediatric patients
H A Kader1, W J Wenner, R N Baldassano
1Division of Gastroenterology and Nutrition, The Children's Hospital of Philadelphia, Pennsylvania, USA.
Insights
Inflammation found with juvenile retention polyps (JRP) is common but does not predict polyp recurrence or inflammatory bowel disease (IBD). This finding may indicate a precursor to JRP development.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Pathology
Background:
- Juvenile retention polyps (JRP) are common colorectal polyps in children.
- The presence of concurrent colonic inflammation with JRP may hold prognostic significance.
- The relationship between abnormal mucosal histology and JRP outcomes requires further investigation.
Purpose of the Study:
- To evaluate the significance of mucosal histology at the time of JRP removal.
- To determine if mucosal histology predicts future inflammatory bowel disease (IBD) development.
- To assess the impact of mucosal histology on JRP recurrence.
Main Methods:
- Retrospective review of medical records for patients undergoing endoscopic polypectomy.
- Analysis of colonic mucosal biopsies obtained during JRP removal.
- Assessment of patient history for IBD diagnosis and polyp recurrence over a mean follow-up of 72.4 months.
Main Results:
- Of 54 patients with biopsies, 44.4% showed colitis, with inflammation at the polyp site in 58.3% of those cases.
- Four patients (16.7%) had IBD at the time of polypectomy; none were diagnosed subsequently.
- No significant difference in polyp recurrence was observed between patients with and without inflammation.
Conclusions:
- Histological mucosal inflammation is frequently observed with JRP.
- This inflammation may be a precursor to JRP but does not predict polyp recurrence.
- Colitis associated with JRP does not appear to be linked to IBD development.
Objective:
The finding of colonic inflammation concurrently with a juvenile retention polyp (JRP) may have prognostic value. However, the significance of abnormal mucosal histology with JRP has not been evaluated. We evaluated the significance of mucosal histology at the time of JRP removal with respect to future development of inflammatory bowel disease (IBD) and polyp recurrence.
Methods:
The medical records of patients who had an endoscopic polypectomy performed at the Children's Hospital of Philadelphia (CHOP) from 1/1/87 through 4/30/98 were retrospectively reviewed.
Results:
JRP was histologically identified in 96 patients. A total of 54 patients had colonic mucosal biopsies: 30 (55.6%) had normal histology and 24 (44.4%) had colitis. Of the 24 patients with colitis, 14 patients (58.3%) had inflammation at the polyp site. Twelve of these patients had additional inflammation elsewhere in the colon. Nine (37.5%) had inflammation elsewhere in the colon; however, biopsies around the polyp site were not obtained. One patient with inflammation did not have the location of the polyp documented. Four patients (16.7%) had IBD at the time of polypectomy; two were diagnosed prior and two coincident with JRP. None have subsequently been diagnosed with IBD. There was no difference in polyp recurrence between those with or without inflammation (16.7% [4/24] vs 10.0% [3/30]). The mean follow-up period was 72.4 months (range, 5-142 months).
Conclusions:
In our experience, histological mucosal inflammation is a common finding with JRP. This inflammation may be a precursor for the development of JRP but has no predictive value for polyp recurrence. This colitis does not seem to be associated with IBD.
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