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Inflammatory cloacogenic polyps in children: diagnostic yield of rectal retroflexion during colonoscopy
You Ie Kim1, Jung Yeon Joo1, Hye Ran Yang2,3
1Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.
Insights
Rectal retroflexion during colonoscopy is useful for detecting inflammatory cloacogenic polyps (ICPs) in children. This technique helps identify ICPs, which are often missed in pediatric patients, especially those with hematochezia.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Surgery
- Endoscopic Diagnostics
Background:
- Inflammatory cloacogenic polyps (ICPs) are rare in children, typically affecting adults.
- ICPs occur near the anal transitional zone and can be missed during standard colonoscopy.
- Early detection and accurate diagnosis are crucial for appropriate management.
Purpose of the Study:
- To evaluate the effectiveness of rectal retroflexion (RR) during colonoscopy for detecting ICPs in pediatric patients.
- To compare the characteristics of ICPs with juvenile polyps (JPs) in children.
- To assess the diagnostic yield of RR in identifying ICPs in the pediatric population.
Main Methods:
- Retrospective review of 1837 colonoscopies performed in 1278 children (September 2003 - August 2020).
- Analysis of laboratory, colonoscopic, and histopathological findings.
- Detection of ICPs using rectal retroflexion (RR) view during colonoscopy.
Main Results:
- Seven cases of ICP were diagnosed, all detected via RR, with routine RR use starting in 2013.
- ICP patients were older and had a family history of colorectal polyps more often than JP patients.
- Significant differences observed in stool occult blood, polyp characteristics, and polypectomy methods between ICP and JP groups; no ICP recurrence noted.
Conclusions:
- Rectal retroflexion during pediatric colonoscopy aids in detecting ICPs, which are often overlooked due to their location.
- This technique is particularly valuable for children presenting with hematochezia.
- RR improves diagnostic accuracy for ICPs in the pediatric population, preventing misdiagnosis.
Background And Aims:
Inflammatory cloacogenic polyps (ICPs) are inflammatory lesions occurring around the anal transitional zone. These are rare in the pediatric population, and most reported cases are found in adults. Therefore, this study aimed to evaluate the usefulness of rectal retroflexion (RR) during colonoscopy in detecting ICPs in children.
Methods:
A total of 1837 colonoscopies were performed in 1278 children between September 2003 and August 2020 at the Seoul National University Bundang Hospital. The laboratory test results and colonoscopic and histopathological findings were retrospectively reviewed. ICP was detected using the RR and was diagnosed based on the histologic findings of the polyp.
Results:
A total of 69 patients were diagnosed with juvenile polyps (n = 62) or ICP (n = 7), with the latter being detected through RR. All children with ICP were diagnosed from 2013 onwards when RR during colonoscopy came to be routinely performed in our medical center. The patients with ICP were older at diagnosis and more associated with a family history of colorectal polyps than JP. Stool occult blood and the polyps' endoscopic characteristics, such as number, location, volume, and shape, significantly varied between the two groups. Additionally, there was a statistically significant difference in the polypectomy method. During the long-term follow-up, there was no recurrence of ICP.
Conclusions:
Due to their location at the anorectal junction, ICPs may be overlooked during colonoscopy, leading to misdiagnosis. Therefore, a retroflexion view during colonoscopy may help detect ICPs in pediatric patients, especially those presenting with hematochezia.
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