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Characterization of Colonoscopies in Preschool Children
Rishi Bolia1, Nikhil Thapar1,2,3, Geoffrey D Withers1
1From the Department of Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, Brisbane, Australia.
Insights
Colonoscopies in preschoolers show rectal bleeding as the main reason for the procedure and juvenile polyps as the most common finding. Cecal and ileal intubation rates are achievable but decrease with younger age.
Area of Science:
- Pediatric Gastroenterology
- Endoscopic Procedures
- Clinical Outcomes
Background:
- Limited data exists on colonoscopy indications, diagnostic yield, and intubation rates in children under six years old.
- Understanding these parameters is crucial for optimizing pediatric endoscopic care.
Purpose of the Study:
- To describe the indications, diagnostic yield, complications, cecal intubation rate (CIR), and ileal intubation rate (IIR) for colonoscopies in preschoolers (<6 years).
- To compare these parameters between different age subgroups within the preschool population.
Main Methods:
- A retrospective review of colonoscopies performed between December 2014 and December 2020 in a tertiary pediatric hospital.
- Data collected included demographics, indications, extent of colonoscopy, CIR, IIR, and histologic findings.
- Preschoolers were stratified into <2 years and 2 to <6 years age groups.
Main Results:
- Out of 1671 colonoscopies, 13% (n=219) were in preschoolers (median age 3.9 years).
- Common indications included rectal bleeding (35%), inflammatory bowel disease (24%), and diarrhea (13%).
- IIR and CIR were lower in preschoolers (81% and 93%) compared to older children (92% and 96.4%), with significantly lower rates in those <2 years (48.1% IIR, 85.1% CIR). Juvenile polyps were the most frequent finding (31%).
Conclusions:
- Rectal bleeding and juvenile polyps are the most common indication and finding, respectively, in preschooler colonoscopies.
- High ileal intubation rates are achievable in young children, but rates decrease with younger age.
- These findings highlight age-specific considerations for colonoscopy in the pediatric population.
Objectives:
The indications, diagnostic yield, complications, and cecal and ileal intubation rates (CIR and IIR) for colonoscopies in children aged <6 years, denoted preschoolers, is unclear since there is limited information for this group. We aimed to describe the above parameters in our cohort of preschoolers undergoing a colonoscopy.
Methods:
Retrospective review of all colonoscopies in a tertiary pediatric hospital between December 1, 2014 to December 31, 2020 was undertaken. Demographic factors, indication for colonoscopy, extent of colonoscopy, CIR, IIR, and histologic findings were noted. Preschoolers were further subdivided into those aged <2 years, and those aged 2 to <6 years.
Results:
One thousand six hundred seventy-one total colonoscopies were performed, of which 13% (n = 219) were in preschoolers with median age 3.9 (range 0.3-5.9) years. Most common indications in preschoolers were rectal bleeding 35% (n = 78), inflammatory bowel disease 24% (n = 53), diarrhea 13% (n = 30), iron-deficiency anemia 11% (n = 25), and abdominal pain 7% (n = 16). IIR and CIR were lower in preschoolers compared to older children, 81% vs 92% ( P = 0.0001), and 93% vs 96.4% ( P = 0.02), respectively, and even lower in those aged <2 years, 48.1% IIR ( P = 0.0001) and 85.1% CIR. Juvenile polyps, 31% (n = 27), were the most common positive finding in preschool children.
Conclusion:
Rectal bleeding was the most common indication and juvenile polyps the most common finding at colonoscopy in preschoolers. A high IIR is achievable in young children but rates are increasingly lower the younger the child.
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