Therapeutic Colonoscopy in Children: Endoscopic Snare Polypectomy and Juvenile Polyps

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Seo, Jeong Kee
Issue Date
Seoul National University College of Medicine
Seoul J Med 1993;34(4):285-294
ColonoscopyPolypectomyChildrenJuvenile polyp
Safety and efficacy of colonoscopic polypectomy without using general
anesthesia in young children with juvenile polyps were studied. Between July 1987 and
June 1993, seventy six colorectal polyps of up to 4.5cm diameter were removed by diathermy
snare during 43 colonoscopic polypectomy sessions on 38 children aged from 6
months to 13 years (mean, 4.4 years). Thirty four children had single polyps. The remaining
four children had more than two polyps. One of them was juvenile polyposis.
General anesthesia was not used in any infant or child. In 31 (82%) patients,
colonoscopic polypectomy was performed on an ambulatory basis. Most juvenile polyps
(89%) occurred as a solitary lesion. In 76% of patients, polyps were located in the
rectosigmoid region. Seventy nine percent of the polypectomized juvenile polyps were
between 1 em and 3 em diameter in size. No complications related to medication,
colonoscopy. or snare polypectomy were observed in any of the children. The major
clinical manifestations of children with juvenile polyps were hematochezia (89%), abdominal
pain (19%), mucoid stools or diarrhea (45%), and anemia (29%). These clinical
symptoms disappeared soon after removal of polyps. In 18 of 33 patients with juvenile
polyps, barium enema did not demonstrate any colonic polyps. More than 6 months'
delay of diagnosis was noted in 40% of patients. Only 32% of patients were diagnosed
to have juvenile polyps within 3 months from the onset of hematochezia. Sixteen
patients (42%) were referred with a clinical impression of colon polyp. However, the remaining
22 patients had been treated before referral under various tentative diagnoses
including dysentery-like infectious diarrhea (34%), anal fissure (11%), hemorrhoid (5%)
and ulcerative colitis (5%). From the experience in the present study, it is concluded
that colonoscopic snare polypectomy can be safely and effectively used at pediatric age for
the treatment of juvenile polyps without using general anesthesia on an ambulatory basis.
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College of Medicine/School of Medicine (의과대학/대학원)Dept. of Medicine (의학과)The Seoul Journal of MedicineThe Seoul Journal of Medicine Vol. 34 No.4 (1993)
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