Clinical, laboratory, and endoscopic features of colorectal polyps in Egyptian children with lower gastrointestinal bleeding

Abstract

Background Pediatric lower gastrointestinal bleeding (LGIB) is a relatively common symptom that merits investigations. Etiologies are heterogeneous, including colorectal polyps, especially in children aged 2–8 years. The majority of childhood polyps are solitary juvenile polyps (JP). Juvenile polyposis syndrome (JPS) involves multiple polyps with risks of anemia and systemic manifestations. Fecal calprotectin (FCP), a widely used marker of gut inflammation, may predict the etiology LGIB and guide endoscopic decisions, but its correlation with polyp features is still understudied. Aim This study aimed to assess the clinical, laboratory, and endoscopic features of colorectal polyps in LGIB. Additionally, we investigated the potential correlation between FCP level and endoscopic features of polyps. Patients and methods This prospective cohort study included all children with colorectal polyps throughout a period of one year from January 2019 to 2020. They were recruited from the cases presenting with chronic LGIB and assigned for colonoscopy at Alexandria University Children’s Hospital. Detailed history taking and clinical examination was performed. Laboratory investigations, including FCP, was done before colonoscopy. The polyps were located, snared and retrieved for histopathological assessment. FCP was measured again for all patient after 2 weeks of polypectomy. Results Among 100 children with LGIB, 22 (22%) patients had colorectal polyps. JP were detected in 86.4%, while 13.6% had JPS. Colorectal polyps were the second common cause of chronic LGIB. The mean age was 4±1.8 years. They had bright red painless rectal bleeding (100%) and normal well-formed stool (95.5%). Iron deficiency anemia was reported in 86.4%. Severe bleeding was reported only in JPS. A single polyp was detected in 81.8%. One patient had two simultaneous polyps. Polyps were large in 63.6% and pedunculated in 81.8%. These solitary JP polyps were hamartomatous and detected in the recto-sigmoid segment. Family history was positive in 9.1%. The rest (three patients, 15.7%) had multiple polyps (10–23), mostly in distal colon but also extended proximally. These polyps were also of hamartomatous origin and diagnosed as JPS. FCP was elevated in 99% of cases and was significantly high in 63.6%. FCP level correlated well with polyp number and extent of colon involvement. All patients showed significant decrease in FCP level 2 weeks postpolypectomy. Delayed postpolypectomy bleeding was reported in one (4.55%) patient with a large solitary polyp. Conclusions In pediatric patients (2–10 years), colorectal polyps represent a frequent cause of LGIB. JPs are usually solitary, located in the rectosigmoid colon and present with mild bright red painless rectal bleeding in otherwise asymptomatic child. FCP level correlate with polyp burden, which suggest the potential use of FCP as a noninvasive diagnostic tool for LGIB evaluation.