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Fiberoptic colonoscopic polypectomy in childhood: report and review of cases
M Uchiyama1, M Iwafuchi, M Yagi
1Niigata University School of Medicine, Department of Pediatric Surgery, First Department of Surgery, Niigata, Japan. uchii@med.niigata-u.ac.jp
Insights
Pediatric colon polyps, often juvenile, require histopathologic examination for accurate diagnosis and management. Fiberoptic colonoscopy and transanal resection are effective for symptomatic polyp removal in children.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Surgery
- Endoscopy
Background:
- Fiberoptic colonoscopy is a standard treatment for pediatric colorectal polyps.
- Optimal bowel preparation, anesthesia, and treatment strategies remain debated.
- This study clarifies the rationale for pediatric colonoscopy.
Purpose of the Study:
- To analyze the outcomes of colonoscopic examinations in pediatric patients with colorectal polyps.
- To evaluate the efficacy and safety of different polypectomy techniques.
- To establish guidelines for the management and follow-up of pediatric colon polyps.
Main Methods:
- Retrospective analysis of 21 pediatric patients (age 1-7 years) with colorectal polyps.
- Colonoscopic examination, flexible colonoscopic polypectomy, and transanal polypectomy were performed.
- Histopathologic examination of all resected polyps was conducted.
Main Results:
- Polyps were most commonly found in the rectum and sigmoid colon.
- Juvenile polyps were the most frequent type, but adenomas and other types were also observed.
- Polypectomy was successful in all patients, with no recurrence reported except in one case of Peutz-Jeghers syndrome.
Conclusions:
- Histopathologic examination is crucial for identifying dysplastic or adenomatous changes in pediatric colon polyps.
- Symptomatic polyps require removal via colonoscopy or transanal resection under general anesthesia.
- Polypectomy with electrocautery snare and clip, along with polyethylene glycol bowel preparation, is safe and effective.
Background:
Fiberoptic colonoscopy has been a routine therapeutic modality for colorectal polyps in pediatric patients. Methods of bowel preparation, anesthesia, area of investigation and treatment depending on histopathology are still controversial. In order to clarify the rationale of pediatric colonoscopy the present study was performed.
Methods And Results:
We analyzed the results of colonoscopic examination in 21 patients with colorectal polyps. Mean patient age was 3.7 years, with a range of 1--7 years. Rectal polyps were seen in 10 cases: seven had a solitary polyp (juvenile in six and adenoma in one) and three had multiple polyps (juvenile, lymphoid and Peutz--Jeghers coexisting with hyperplastic polyps). Sigmoid colon polyps were seen in 10 cases: all were solitary juvenile polyps, but one had adenomatous change. Another had multiple Peutz-- Jeghers polyps located in the entire colon. Flexible colonoscopic polypectomy was performed in 16 patients and transanal polypectomy was performed in four patients. Autoamputation was seen in two cases of juvenile polyp (resection was ultimately performed in a case having repeated autoamputation). After removing the polyps, all patients have had no recurrence for a period ranging from 6 months to 15 years, except for one case with Peutz--Jeghers syndrome.
Conclusions:
Most polyps are located in the rectum or the sigmoid colon. Although the majority are solitary or juvenile polyps, because histopathologic variety is seen in pediatric colon polyps, histopathologic examination of each polyp is important to detect any dysplastic or adenomatous element with malignant potential and to make a suitable follow-up schedule. Symptomatic polyps should be removed by fiberoptic colonoscopy or transanal resection with total colon endoscopic examination under general anesthesia. Polypectomy using the electrocautery snare and clip is effective and safe and bowel preparation using polyethylene glycol electrolyte solution is sufficient for the procedure.