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Colonic polyps: experience of 236 Indian children
U Poddar1, B R Thapa, K Vaiphei
1Department of Gastroenterology and Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Juvenile polyps are the most common colonic polyps in Indian children, often presenting with rectal bleeding. Early removal is recommended due to neoplastic potential, and colonoscopic polypectomy is effective even for juvenile polyposis.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Surgery
- Pediatric Pathology
Background:
- Colonic polyps in children are uncommon but require careful evaluation.
- Juvenile polyps are the most frequent type, with potential for adenomatous changes.
Purpose of the Study:
- To investigate the clinical features, histology, and malignant potential of colonic polyps in Indian children.
- To assess the efficacy of colonoscopic polypectomy in managing pediatric colonic polyps.
Main Methods:
- A study of 236 children (≤12 years) with colonic polyps from 1991-1996.
- Clinical evaluation, colonoscopic polypectomy, and histological examination of polyps.
- Serial colonoscopies for juvenile polyposis and colectomy for intractable symptoms.
Main Results:
- The majority of polyps (93%) were juvenile, predominantly in the rectosigmoid area (85%).
- Adenomatous changes were observed in 11% of polyps, more frequently in juvenile polyposis (59%).
- Colonoscopic polypectomy was effective, though colectomy was needed for severe cases; recurrence rates varied by polyp type.
Conclusions:
- Juvenile polyps are the most common colonic polyps in children, necessitating total colonoscopy due to potential for multiple and proximal lesions.
- Even asymptomatic juvenile polyps require removal due to neoplastic potential.
- Colonoscopic polypectomy is an effective treatment for juvenile polyposis, with surveillance colonoscopy indicated for this condition.
Objectives:
We studied the clinical spectrum, histology, and malignant potential of colonic polyps in Indian children (< or =12 yr).
Methods:
Two hundred thirty-six children with colonic polyps were studied from January 1991 to October 1996. They were evaluated clinically and colonoscopic polypectomy was done. Children with five or more juvenile polyps were labeled as having juvenile polyposis and serial colonoscopic polypectomies were done every 3 wk. Colectomy was performed when there were intractable symptoms or clearing of the polyps by colonoscopy was not possible. Histological examination of the polyps was done. Follow-up colonoscopy was done in children with juvenile polyposis only.
Results:
The mean age of these children was 6.12 +/- 2.7 yr, with a male preponderance (3.5:1). Rectal bleeding of a mean duration of 14 +/- 16 months was the presenting symptom in 98.7%. Solitary polyps were seen in 76%, multiple polyps in 16.5%, and juvenile polyposis in 7% (n = 17) of the children. A majority (93%) of the polyps were juvenile and 85% were rectosigmoid in location. Adenomatous changes, seen in 11%, were more common in juvenile polyposis (59%) than in juvenile polyps (5%). Among those with juvenile polyposis, colon clearance was achieved in eight, six required colectomy for intractable symptoms, and three were still on the polypectomy program. Polyps recurred in 5% of children with juvenile polyps and 37.5% of those with juvenile polyposis.
Conclusions:
Juvenile polyps remain the most common colonic polyps in children. A significant number of cases of polyps are multiple and proximally located, which emphasizes the need for total colonoscopy in all. Juvenile polyps should be removed even if asymptomatic because of their neoplastic potential. Colonoscopic polypectomy is effective even in juvenile polyposis. Surveillance colonoscopy is required in juvenile polyposis only.
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