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[DIAGNOSTIC AND THERAPEUTIC COLONOSCOPY IN PEDIATRICS]
Insights
In children, polyps are the primary cause of lower gastrointestinal bleeding, often presenting as rectorrhagia and anemia. Colonoscopy is a safe and effective diagnostic and treatment method for these cases.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Surgery
Background:
- Lower gastrointestinal bleeding is uncommon in children but can be an emergency.
- Polyps are the predominant cause of lower gastrointestinal bleeding in pediatric patients.
Purpose of the Study:
- To investigate the clinical course, histologic characteristics, and treatment of lower gastrointestinal bleeding in children.
- To evaluate the efficacy and safety of colonoscopy for diagnosis and treatment of pediatric lower gastrointestinal bleeding.
Main Methods:
- Retrospective study of 74 children under 14 years old who underwent colonoscopy for gastrointestinal bleeding between 1990 and 1996.
- Analysis of colonoscopy findings, polyp types, treatment procedures (polypectomy), and complications.
- Histological examination of removed polyps.
Main Results:
- Polyps caused lower gastrointestinal bleeding in 71.6% of cases.
- Juvenile polyps were the most frequent type (56.66%), followed by tubular adenoma (11.32%).
- All patients presented with rectorrhagia and anemia; polypectomy was successful in 94.34% with minimal morbidity.
Conclusions:
- Polyps are the leading cause of lower gastrointestinal bleeding in children.
- Colonoscopy is a safe and effective diagnostic and therapeutic tool for pediatric lower gastrointestinal bleeding, manageable in an endoscopy unit.
- Juvenile polyps are the most common histological finding in pediatric lower gastrointestinal bleeding cases.
Abstract:
Gastrointestinal bleeding in childhood is an uncommon problem, althought when it happens it maybe an emergency. Upper bleeding predominates, and when we consider lower bleeding, the principal cause are polyps. Recent evidence points out that polyps are responsible for bleeding in 77% of cases.We decided to study the clinical course, histologic characteristics and treatment in children with lower gastrointestinal bleeding. This investigation was held at Edgardo Rebagliati National Hospital during 1990 to 1996. Inclusion criteria were: younger than 14 years, gastrointestinal bleeding, and colonoscopy exam.100 colonoscopies were done in 74 children. Polyps were the cause for gastrointestinal bleeding in 71.6% of cases. In 14 children more than one colonoscopy was done. More than one polyp in 16 children were found. Ulcerative colitis was diagnosed in two cases, and intestinal tuberculosis in other two cases. Average age was 8.8 years, and 100% presented rectorragia and anemia.Polyps were located principally in rectum and sigmoid. Polipectomy was done in 94.34% of the cases, and it was technically succesful. We had only one complication (snare wire was trapped) but with no morbidity.Histological examination demonstrated that juvenile polyp was the most frequent type (56.66%), followed by tubular adenoma (11.32%), and Peutz-Jegher polyp in 3.77%. Treatment was polipectomy in all cases. Eleven procedures were done in the surgical room, and 19 in the endoscopy unit, with no complications in any of the cases.CONCLUSION: In children the main cause for lower gastrointestinal bleeding are polyps. All cases present with rectorragia or anemia, and juvenile polyps are the most frequent type. Colonoscopy is a safe method for diagnosis and treatment, which can be done in the endoscopy unit with mild sedation and with an anesthesist or pediatrician as assistants.