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

Year 2024, Volume: 26 Issue: 3, 276 - 283, 24.12.2024

Sevinç Garip , Sibel Çetinalp , Elife Aşut

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

Ethical Statement

Ethical approval Ethics committee approval was received for the study from the Medical Research Ethics Committee of Health Sciences University Adana City and Training and Research Hospital, dated 29.02.2024 and numbered 3206/147.

Supporting Institution

yoktur

Thanks

I would like to thank the anesthesiologist who administered anesthesia during all colonoscopies and the pathology physicians who evaluated the biopsies.

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

References

• Walker WA, Durie PR, Hamilton JR, Walker- Smith JA, Watkins JB. eds. Pediatric Gastrointestinal Disease. 3rd ed. B.C. Decker, Ontario, 2000;976-986.
• Gilger MA, Gold BD. Pediatric endoscopy: New information from the PEDS-CORI project. Curr Gastroenterol. Rep. 2005;7(3):234-239.
• Park JH. Role of colonoscopy in the diagnosis and treatment of pediatric lower gastrointestinal disorders. Korean J. Pediatr. 2010;53:824-829.
• Friedt M, Welsch S. An update on pediatric endoscopy.Eur J Med Res. 2013:18(1):24.
• Kay M, Wyllie R. Esophagogastroduodenoscopy, colonoscopy and related techniques. In: Wyllie R, Hyams JS, editors. Pediatric Gastrointestinal and Liver Disease. Pathophysiology, Diagnosis, Management. 3rd ed. Philadelphia: Saunders Elsevier. 2006:1251-89.
• Jae Hong Park. Pediatric Colonoscopy: The changing patterns and single institutional experience over a decade. Clin Endosc. 2018;51:137-141.
• Nambu R, Hagiwara S-I, Kakuta F et al. Current role of colonoscopy in infants and young children: A multicenter study. BMC Gastroenterol. 2019;19(1):149.
• Tam YH, Lee KH, Chan KW, Sihoe JDY, Cheung ST, Mou JWC. Colonoscopy in Hong Kong Chinese children. World J. Gastroenterol. 2010;16:1119-1122.
• Karhan AN, Tuncel F, Usta Y. Assessment of colonoscopic findings in pediatric patients: A single center experience. Mersin Üniv Sağlık Bilim Derg. 2021;14(3):475-483.
• Lee YW, Chung WC, Sung HJ, et al. Current status and clinical impact of pediatric endoscopy in Korea. Korean J Gastroenterol. 2014;64(6):333-339.
• Lei P, Gu F, Hong L, et al. Pediatric colonoscopy in South China: A 12-year experience in a tertiary center. PLoS One. 2014;23;9(4):e95933.
• Stringer MD, Pinfield A, Revell L, McClean P, Puntis JW. A prospective audit of paediatric colonoscopy under general anaesthesia. Acta Paediatr. 1999;88(2):199-202.
• Jan SA, Ajmal G, Naimatullah Z. Colonoscopic finding in children with lower gastrointestinal complaints. JGH Open: An open access journal of gastroenterology and hepatology. 2023;7(12):863-868.
• Sawczenko A, Sandhu BK, Logan RF, et al. Prospective survey of childhood inflammatory bowel disease in the British Isles. Lancet. 2001;357(9262):1093-1094.
• Kugathasan S, Judd RH, Hoffmann RG, et al. Epidemiologic and clinical characteristics of children with newly diagnosed inflammatory bowel disease in Wisconsin: A statewide population-based study. J Pediatr. 2003;143(4):525-531.
• Newby EA, Croft NM, Green M, et al. Natural history of paediatric inflammatory bowel diseases over a 5-year follow-up: A retrospective review of data from the register of paediatric inflammatory bowel diseases. J Pediatr Gastroenterol Nutr. 2008;46(5):539-545.
• Lindberg E, Lindquist B, Holmquist L, Hildebrand H. Inflammatory bowel disease in children and adolescents in Sweden, 1984-1995. J Pediatr Gastroenterol Nutr. 2000;30(3):259-264.
• Weinstein TA, Levine M, Pettei MJ, Gold DM, Kessler BH, Levine JJ. Age and family history at presentation of pediatric inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2003;37(5):609-613.
• Yoshioka S, Takedatsu H, Fukunaga S, et al. Study to determine guidelines for pediatric colonoscopy. World J Gastroenterol. 2017;23(31):5773-5779.
• Wang XQ, Zhang Y, Xu CD, et al. Inflammatory bowel disease in Chinese children: A multicenter analysis over a decade from Shanghai. Inflamm Bowel Dis. 2013;19(2):423-428.
• Durno CA. Colonic polyps in children and adolescents.Can J Gastroenterol. 2007;21(4):233-239.
• Kay M, Engb K, Wylliea R. Colonic polyps and polyposis syndromes in pediatric patients. Curr Opin Pediatr. 2015;27(5):634-641.
• Thakkar K, Alsarraj A, Fong E, Holub JL, Gilger MA, El Serag HB. Prevalence of colorectal polyps in pediatric colonoscopy. Dig Ds Sci. 2012;7:1050-1055.
• Wei C, Dayong W, Liqun J, Xiaoman W, Yu W, Xiaohong Q. Colorectal polyps in children: A retrospective study of clinical features and the value of ultrasonography in their diagnosis. J. Pediatr. Surg. 2012;47(10):1853-1858.
• Deeb MM, El-Zayat RS, El HAAEA. Colonoscopic findings in children with lower gastrointestinal bleeding. Menoufia Med. J. 2016;29:247.
• Gupta SK, Fitzgerald JF, Croffie JM, et al. Experience with juvenile polyps in North American children: The need for pancolonoscopy. Am J Gastroenterol. 2001;96(6):1695-1697.
• Thirumal P, Sumathi B, Nirmala D. A clinical entity often missed-solitary rectal ulcer syndrome in children. Front Pediatr. 2020;8:396.
• Abusharifah O, Bokhary RY, Mosli MH, Saadah OI. Solitary rectal ulcer syndrome in children and adolescents: A descriptive clinicopathologic study. Int J Clin Exp Pathol. 2021;14(4):399-407.
• Poddar U, Yachha SK, Krishnani N, Kumari N, Srivastava A, Sarma MS. Solitary rectal ulcer syndrome in children: A report of 140 cases. J Pediatr Gastroenterol Nutr. 2020;71(1):29-33.
• Kowalska-Duplaga K, Lazowska-Przeorek I, Karolewska- Bochenek K, et al. Solitary rectal ulcer syndrome in children: A case series study. Adv Exp Med Biol. 2017;1020:105-112.