Pediatrik Hastalarda Kolonoskopinin Tanı ve Tedavideki Rolü; Tek merkez 6 Yıllık Deneyim

Abstract

Amaç: Pediatride kolonoskopi gastrointestinal sistem hastalıklarında tanı ve tedavi amacıyla rutin olarak güvenli ve etkin şekilde kullanılmaktadır. Çocukluk çağında en sık görülen kolonoskopi endikasyonları; alt gastrointestinal kanama, kronik ishal ve kronik karın ağrısıdır. Kliniğimizde kolonoskopi yapılan çocuk hastaların özelliklerini retrospektif olarak incelenerek literatüre katkı sağlamak amaçlandı. Gereç ve Yöntemler: Ağustos 2017 ile Ağustos 2022 tarihleri arasındaki 6 yıllık dönemde tek pediatrik gastroenterolog tarafından kolonoskopi yapılan çocuk hastalar dahil edildi. Hastalar dört farklı yaş grubuna ayrılarak özellikleri karşılaştırıldı. Ayrıca iki farklı dönemde yapılan kolonoskopilerde farklılık araştırıldı. Bulgular: Çalışmada 551 hastaya 614 kolonoskopi yapıldı. Hastaların yaş ortalaması 12.3±4.7’di, %51.9'u kadın, %48.1'i erkekti. İki yaşın altında %2.2; 2-6 yaş arası %8.3; 6-12 yaş arası %22.7 iken, 12 yaş üzeri hasta oranı %66.8’di. Hastaların %40.5'inin tek şikayeti, %30.7'sinin iki şikayeti, %28.8'inin üç ve daha fazla şikayeti vardı. En sık görülen şikâyet %31 (n=171) kronik ishal olurken, %16.7 rektal kanama (n=92), %13 kanlı mukuslu dışkılama (n=71) idi. Başlıca kolonoskopi endikasyonları; inflamatuvar bağırsak hastalığı şüphesi (n=406, %73.7), kolorektal polip araştırılması (n=72, %13.1), malignite taraması (n=35, %6.4), alt gastrointestinal sistem kanamasıdır (n=35, %6.4). En sık görülen kolonoskopi bulguları %32.3 (n=178) ile inflamatuvar bağırsak hastalığı, %4.2 (n=23) ile kolorektal polip, %3.3 (n=18) ile soliter rektal ülserdi. Kolonoskopilerin %49.7'si normal, %4.2'si kirliydi. Kolonoskopide ileum entübasyon başarı oranı %92.4 idi. Komplikasyon yaşanmadı. Sonuç: Gastrointestinal sistem belirti ve semptomlarıyla başvuran pediatrik hastalarda, biyopsi ve kolonoskopinin daha aktif, güvenli ve etkili bir şekilde yapılmasıyla inflamatuvar bağırsak hastalığı başta olmak üzere birçok hastalığın erken doğru tanı ve tedavisini sağlayacaktır.

Keywords

• Çocuk
• kolonoskopi
• polip
• inflamatuvar barsak hastalığı

THE ROLE OF COLONOSCOPY IN PEDIATRIC DIAGNOSIS AND TREATMENT: A 6-YEAR SINGLE-CENTER EXPERIENCE

Abstract

Objective: In pediatrics, colonoscopy is routinely used safely and effectively for the diagnosis and treatment of gastrointestinal system diseases. The most common colonoscopy indications in childhood are; lower gastrointestinal bleeding, chronic diarrhea and chronic abdominal pain. We aimed to contribute to the literature by retrospectively examining the characteristics of pediatric patients who underwent colonoscopy in our clinic. Material and Methods: Pediatric patients who underwent colonoscopy by a single pediatric gastroenterologist during the 6-year period between August 2017 and August 2022 were included. The patients were divided into four different age groups and their characteristics were compared. Additionally, differences were investigated in colonoscopies performed in two different periods. Results: In the study, 614 colonoscopies were performed in 551 patients. The average age of the patients was 12.3±4.7, 51.9% were female and 48.1% were male. 2.2% under two years of age; 8.3% between 2-6 years old; while the rate of patients aged 6-12 was 22.7%, the rate of patients over 12 years of age was 66.8%, 40.5% of the patients had one complaint, 30.7% had two complaints, 28.8% had three or more complaints. The most common complaint was chronic diarrhea in 31% (n=171), rectal bleeding in 16.7% (n=92), and bloody mucus stools in 13% (n=71). Main colonoscopy indications: suspicion of inflammatory bowel disease (n=406, 73.7%), colorectal polyp investigation (n=72, 13.1%), malignancy screening (n=35, 6.4%), lower gastrointestinal tract bleeding (n=35, 6.4%). The most common colonoscopy findings were inflammatory bowel disease with 32.3% (n=178), colorectal polyp with 4.2% (n=23), and solitary rectal ulcer with 3.3% (n=18). 49.7% of colonoscopies were normal and 4.2% were dirty. The ileum intubation success rate in colonoscopy was 92.4%. There were no complications. Conclusion: In pediatric patients presenting with gastrointestinal system signs and symptoms, performing biopsy and colonoscopy more actively, safely and effectively will provide early accurate diagnosis and treatment of many diseases, especially inflammatory bowel disease.

Keywords

• Child
• colonoscopy
• polyp
• inflammatory bowel disease

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