Gastrointestinal polyps in children

Yalinkaya Z, Gastrointestinal System Polyps in Children, Hacettepe University Faculty of Medicine, Department of Pediatrics, Thesis of Pediatrics, 2021. Polyps are less common in children than adults. In childhood, gastrointestinal polyps may present with rectal bleeding, abdominal pain, change in bowel habits, intussusception, protein-losing enteropathy, prolapse of the rectum or polyp. Polyps which are the most common cause of rectal bleeding in toddlers are seen in 1% of preschool children. The definitive diagnosis of gastrointestinal polyps is made by clinical findings, determination of the pathological features of the polyp that is removed by endoscopy or surgery. This study is a retrospective study that included 64 patients who were diagnosed with gastrointestinal polyps as a result of endoscopic and histopathological examinations between January 1ˢᵗ, 2001 and December 31ˢᵗ, 2020, at Hacettepe University Faculty of Medicine, Department of Pediatric Gastroenterology. Between between January 1ˢᵗ, 2001 and December 31ˢᵗ, 2020, a total of 5186 endoscopic procedures, 3643 of which were esophagogastroduedonoscopy and 1543 of which were colonoscopy, were performed in Hacettepe University Faculty of Medicine, Department of Pediatric Gastroenterology. Polyps were detected in 79 (2.16%) of esophagogastroduedonoscopies, 131 (8.48%) of colonoscopies, and 210 (4.04%) of all endoscopic procedures. Thirty-five (54.7%) of the patients included in the study were girls and 29 (45.3%) were boys, and their mean age at diagnosis of polyp was 8.5±4.6 years (9 months-17.2 years). The mean body weight z scores of the patients at the time of diagnosis were -0.45±-0.87; mean height z score was -0.32±-0.13. While 7 (10.9%) patients in the study had no symptoms, the most common complaints were rectal bleeding in 33 (51.6%) patients and abdominal pain in 6 (9.4%) patients. Endoscopic examination revealed only 1 polyp in 33 (51.6%) of the patients, 2-4 polyps in 7 (10.9%) and five or more than five polyps in 24 (37.5%) patients. Considering the gastrointestinal locations of the polyps; there were polyps in the lower gastrointestinal tract in 43 (67.2%) patients, in the upper gastrointestinal tract in 8 (12.5%) patients, and in the upper and lower gastrointestinal tract in 13 (20.3%) patients. The surface of the polyps was ulcerated in 41 (64.1%) patients, and the polyps were covered with normal mucosa in 23 (35.9%) patients. As a result of clinical, endoscopic and pathological examinations of the patients; juvenile polyps in 24 patients (37.5%), familial adenomatous polyposis in 8 patients (12.5%), Peutz-Jeghers syndrome in 6 (9.4%) patients, juvenile polyposis coli syndrome in 5 (7.8%) patients, hyperplastic polyps in 4 (6.3%) patients, Gardner syndrome in 2 (3.1%) patients, and Lynch syndrome, Cowden syndrome, Bannayan Riley Rubancava syndrome, reflux esophagitis, squamous papilloma and tubulovillous adenoma were diagnosed in 1 (1.6%) patient. Familial polyposis syndrome was diagnosed in 24 (37.5%) patients. There was a family history of polyps in 13 (20.3%) of the patients. Genetic mutation analysis was performed in 4 (6.3%) patients; APC mutation was detected in 2 patients, PTEN and STK 11 mutations were found in one patient each. Endoscopic polypectomy in 51 (79.7%) patients, total colectomy in 10 (15.6%) patients, partial small bowel resection in 2 (3.1%) patients, partial colectomy in 1 (1.6%) was done.