Endoscopic Findings in Children with Isolated Lower Gastrointestinal Bleeding

Abstract

Background/Aims Colorectal polyps are a common cause of lower gastrointestinal bleeding in children. Our aim was to study the causes of isolated lower gastrointestinal bleeding and to analyze the characteristics of the colorectal polyps found in our cohort. Methods We retrospectively reviewed colonoscopic procedures performed between 2007 and 2015. Children with isolated lower gastrointestinal bleeding were included in the study. Results A total of 185 colonoscopies were performed for isolated lower gastrointestinal bleeding. The median patient age was 8 years, and 77 patients (41.6%) were found to have colonic polyps. Normal colonoscopy findings were observed and acute colitis was detected in 77 (41.6%) and 14 (7.4%) patients, respectively. Single colonic polyps and 2–3 polyps were detected in 73 (94.8%) and 4 (5.2%) patients with polyps, respectively. Of the single polyps, 69 (94.5%) were juvenile polyps, among which 65 (94.2%) were located in the left colon. Conclusions Single left-sided juvenile polyps were the most common cause of isolated lower gastrointestinal bleeding in our study. It was rare to find multiple polyps and polyps proximal to the splenic flexure in our cohort. A full colonoscopy is still recommended in all patients in order to properly diagnose the small but significant group of patients with pathologies found proximal to the splenic flexure.

Faecal calprotectin and ultrasonography as non-invasive screening tools for detecting colorectal polyps in children with sporadic rectal bleeding: a prospective study

“…Chair of Pediatrics, NESMOS Department, Sapienza University of Rome, Sant'Andrea University Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy. 2 Pediatric Radiology Unit, Santobono-Pausilipon Children Hospital, Naples, Italy. 3 Department of Woman, Child and General and Specialistic Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy.…”

“…Colorectal polyps are reported in 6,1% of paediatric colonoscopies and in 12% of those performed for lower gastrointestinal bleeding. However, these lesions occur much more often than is clinically recognized because many of these polyps simply outgrow their blood supply, become ischaemic, and autoamputate with moderate painless haematochezia [1][2][3].…”

The Most Common Cause of Lower Gastrointestinal Bleeding without Other Symptoms in Children is Colonic Polyp: Is Total Colonoscopy Needed?

“…Although some cases of lower gastrointestinal bleeding can be diagnosed clinically [2], diagnosis is challenging in children with lower gastrointestinal bleeding without other symptoms. Silbermintz et al [3] described the role of endoscopic examination for diagnosis in children with lower gastrointestinal bleeding without other symptoms. The most common cause of asymptomatic lower gastrointestinal bleeding in children is juvenile polyps [2,4]; therefore, suspected juvenile polyps in children serve as an indication for colonoscopy.…”

“…A multicenter study investigating 13,115 children who underwent colonoscopy in the USA reported that polyps were detected in 6.1% of all children who underwent colonoscopy and in 12% of children with lower gastrointestinal bleeding [5]. A study by Silbermintz et al [3] excluded children with clinically suspected inflammatory bowel disease, those with previously diagnosed polyps, and those with familial adenomatous polyposis. Therefore, it is not possible to directly compare the prevalence of colon polyps with that reported in other studies.…”

“…Therefore, it is not possible to directly compare the prevalence of colon polyps with that reported in other studies. Nevertheless, Silbermintz et al [3] reported that 41.6% of children who underwent colonoscopy for lower gastrointestinal bleeding without other symptoms were diagnosed with colonic polyps. This indicates that although colonoscopy is challenging in children, this examination is needed because of the relatively high incidence of polyps in children with lower gastrointestinal bleeding without other symptoms.…”