Abstract
BackgroundColorectal polyps are reported in 6,1% of paediatric colonoscopies and in 12% of those performed for lower gastrointestinal bleeding. Although colonoscopy is widely used in paediatric patients, it requires bowel preparation and general anaesthesia or deep sedation, and in rare cases, it can cause complications. Non-invasive screening techniques able to predict polyps in children with isolated and sporadic rectal bleeding may play a key role in the selection of patients needing colonoscopy.MethodsWe enrolled all children undergoing colonoscopy for isolated and sporadic rectal bleeding to determine the diagnostic accuracy of faecal calprotectin, ultrasonography (US) and digital rectal examination as diagnostic methods for screening colorectal polyps.ResultsA total of 26 of 59 enrolled patients (44.1%) had colonic polyps, one patient had multiple polyps, and 23% of children had polyps proximal to the splenic flexure. The diagnostic accuracy of faecal calprotectin for detecting colorectal polyps was 96.6%, with a sensitivity of 100%. False-positive faecal calprotectin was shown in 2 patients with non-steroidal anti-inflammatory drug-related lesions. The diagnostic accuracy of ultrasound was 77.9%. Polyps not seen with ultrasound tended to be relatively smaller (1.5 vs 2.3, p = 0.001) and located in the rectum. The combined use of FC, US and digital rectal examination obtained a specificity and PPV of 100%.ConclusionsFC combined with US and digital rectal examination is a good and promising non-invasive screening test for detecting colorectal polyps in children with isolated and sporadic rectal bleeding.
Highlights
Colorectal polyps are reported in 6,1% of paediatric colonoscopies and in 12% of those performed for lower gastrointestinal bleeding
We prospectively enrolled all 1–18-year-old patients referred to the Pediatric Gastroenterology Unit of Santobono-Pausilipon Children’s Hospital of Naples from June 2017 to April 2019 who underwent colonoscopy due to sporadic lower gastrointestinal bleeding
The present study showed a 14.9% prevalence of colorectal polyps in children undergoing colonoscopy for lower gastrointestinal bleeding
Summary
Non-invasive screening techniques able to predict polyps in children with isolated and sporadic rectal bleeding may play a key role in the selection of patients needing colonoscopy. Colorectal polyps are reported in 6,1% of paediatric colonoscopies and in 12% of those performed for lower gastrointestinal bleeding. These lesions occur much more often than is clinically recognized because many of these polyps outgrow their blood supply, become ischaemic, and autoamputate with moderate painless haematochezia [1,2,3]. Large pedunculated polyps may be pushed distally by peristalsis, leading to intussusception or, in cases of low-rectal polyps, anal prolapse [4, 6, 7]
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