Current role of colonoscopy in infants and young children: a multicenter study

Abstract

Background To evaluate the role of colonoscopy in infants and young children and clarify the distribution of colonoscopy-requiring diseases in this age group. Methods Cohorts of colonoscopies performed at three children’s hospitals in Japan between April 2011 and March 2016 including infants and children younger than six years of age were retrospectively reviewed. Results In total, 453 colonoscopies were performed in 276 infants and young children. Of these 275 (60.8%) were for diagnostic purposes, 177 (39.2%) were performed as follow-up, and one case was performed for treatment. The median patient age at the time of diagnostic colonoscopy was 2.49 years, and there was a male-to-female ratio of 1.72:1. Abnormal macroscopic and/or histopathological findings were noted in 212 (77.1%) cases. Of these, definite diagnoses were established for the presence of eosinophilic gastrointestinal disorders (EGIDs), inflammatory bowel disease (IBD), and polyp/polyposis in 23, 18.5, and 14% of patients, respectively. Among 51 IBD cases, ulcerative colitis, Crohn’s disease, and IBD-unclassified were identified in 47.1, 33.3, and 7.8%, retrospectively via endoscopic examination. Of these, 11 (22%) were eventually diagnosed with monogenic diseases via genetic testing. Of those with rectal bleeding, EGIDs, polyps/polyposis, and IBD were found in 27, 19, and 18%, retrospectively. There were significantly more cases of EGIDs and fewer ones of IBD and polyps/polyposis in patients with rectal bleeding younger than two years of age. Furthermore, 68% of all follow-up colonoscopies were performed in children with IBD. There were no serious complications in our study cohort. Conclusion We determined the role of colonoscopy in infants and young children. Diseases diagnosed using colonoscopy in this age group included IBD, EGIDs, and polyps/polyposis. The increasing trend of patients with IBD and EGIDs worldwide means that the role of colonoscopy in infants and younger children will be more important in the future.

Colonoscopic Diagnosis of Postoperative Gastrointestinal Bleeding in Patients With Hirschsprung's Disease

“…Colonoscopy has been widely used in the diagnosis and treatment of lower gastrointestinal bleeding in children ( 5 ). Total colonoscopy is now very common for patients over 1 year old ( 15 ). However, in our study, this subset of patients has distinctive features, and the operating technique of colonoscopy is different from the reports when diagnosing lower gastrointestinal bleeding.…”

Insufflation of Carbon Dioxide versus Air During Colonoscopy Among Pediatric Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…13,14 To date, novel advancements have been made in the diagnostic and therapeutic areas of endoscopy, including visualization of the intestinal mucosa and insufflation. 15,16 Rogers 17 conducted a small study that first reported on the benefit of using CO 2 insufflation during colonoscopy, owing to the properties of fast absorption and improvement of adverse events caused by abdominal distention; since then CO 2 has been used for a wide variety of endoscopic procedures. 14,[18][19][20] However, evidence for the use of CO 2 insufflation during colonoscopies among pediatric population remains scarce, with data largely extrapolated from adults.…”

Very Early-Onset Inflammatory Bowel Disease: A Challenging Field for Pediatric Gastroenterologists

“…Endoscopies have been performed widely, even in infants. They are informative and has a satisfactory safety profile [ 28 ]. Some unique endoscopic findings have been reported for some monogenic IBDs, such as the leopard sign in chronic granulomatous disease (CGD) [ 29 ].…”