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

Abstract

Background: Colorectal 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. Methods: We 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. Results: A 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%. Conclusions: FC 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.

Juvenile Polyps in Bangladeshi Children and Their Association with Fecal Calprotectin as a Biomarker

“…Until now, only a few conditions other than IBD have been reported with elevated FCP. No diagnostic noninvasive markers have been evaluated for screening individuals with juvenile polyps, and only sporadic case studies and a recent study have been published on children with solitary juvenile polyps and elevated levels of FCP [ 21 ].…”

Potential Utility of Fecal Calprotectin in Discriminating Colorectal Polyps From Other Major Etiologies in Children Presenting With Isolated Hematochezia

“…In our study, the most common cause of isolated hematochezia was colorectal polyps (27.6%), which are in line with previous studies of 19.5–44.1%. 1 11 13 However, unlike previous studies we were also capable of identifying a relatively high proportion of patients with anal fissures (14.2%). Although, anal fissures can be observed by inspection and a history of constipation, there are uncertain cases in which the fissures are located in the anal canal or cases of an insufficient physical exam owing to the unwillingness of the child to cooperate.…”

“… 8 Meanwhile, recent studies have shown that FC may have a role in detecting and furthermore monitoring recurrence in colorectal polyps. 9 10 11 12 Considering the aforementioned conditions of children presenting with isolated hematochezia, FC may be able to discriminate colorectal polyps from different diseases and conditions before conducting an endoscopy.…”

Inflammatory cloacogenic polyps in children: diagnostic yield of rectal retroflexion during colonoscopy

“…Recently, it is known that fecal calprotectin, which is an important non-invasive marker of GI diseases such necrotizing enterocolitis and inflammatory bowel disease, is also elevated in colorectal polyps. In previous studies, fecal calprotectin combined with ultrasonography and DRE was a good screening tool to detect colorectal polyps [ 10 , 29 ]. Therefore, further studies on the differences in fecal calprotectin and DRE between JP and ICP in pediatric patients may be needed.…”