Clinical, Epidemiologic, and Endoscopic Profile in Children and Adolescents With Colonic Polyps in Two Reference Centers

Abstract

-Background -The main goal of this paper is to investigate the frequency, clinical profile, and endoscopic findings of children and teenagers submitted to colonoscopies. Methods -Patients of below 18 years of age, diagnosed with polyps by means of colonoscopies at two reference centers of pediatric endoscopy were followed-up between 2002 and 2012. The clinical variables evaluated in this study included: gender, recommendation of colonoscopy, associated signs and symptoms, age of onset of symptoms, age at identification of the polyp, interval of time between the onset of symptoms and the endoscopic diagnosis of colonic polyps, and family history of intestinal polyposis and/or colorectal cancer. The characteristics of the polyps also included: number, morphological type, histology, and distribution. Polyposis syndromes were also investigated. Results -From the 233 patients submitted to colonoscopies, polyps were found in 74 (31.7%) patients, with a median age of 6.6 years, of which 61% were male. Juvenile polyps were identified in 55 (74%) patients, with 7 (9%) characterized within the criteria for juvenile polyposis. Patients with intestinal polyposis syndromes were diagnosed in 35% of the patients. The most frequent clinical presentation was hematochezia. Abdominal pain with acute episodes of intestinal partial obstruction or intussusception with emergency laparotomy was observed in the majority of Peutz-Jeghers syndrome patients leading to an increased morbidity. Conclusions -Even though juvenile colonic polyps are the most frequent type of diagnosed polyps, the present study identified a significant level of children with polyposis syndromes (35%), associated with a higher morbidity of these individuals.

Juvenile polyp and polyposis syndrome: Experience at a tertiary hospital of Bangladesh

“…Andrade DO et al studied 74 children with colonic polyp and found the mean age was 6.6 years and that 61% were male. Juvenile polyps were identified in 65% patients whilst 35% were diagnosed with polyposis syndromes 18 .…”

O que falar para a família? A predisposição para o câncer infantil hereditário

“…Detectada precocemente por análise molecular do DNA (deoxyribonucleic acid/ ácido desoxirribonucleico) em amostras de sangue, para os afetados recomenda-se a vigilância regular com endoscopia periódica e colectomia precoce para redução dos casos de câncer colorretal. Os casos não tratados apresentam risco de quase 100% de desenvolver carcinoma colorretal (Andrade et al, 2015).…”

Giant tubular adenoma with malignancy clinical characteristics in a female teenager

“…[ 8 ] In a study performed by Andrade DO on 233 children, in 2 reference centers, 74% were identified with juvenile polyps, among 35% with intestinal polyposis syndromes. [ 6 ] Familial adenomatous polyposis, defined by innumerous adenomatous polyps in the entire gastrointestinal tract, [ 6 ] is usually diagnosed in a context of a positive familial history. [ 12 ] Even though the adenomatous polyposis coli (APC) gene seems to be involved in the development of familial adenomatous polyposis, “new mutations” have also been described in up to 30% of patients with this condition, the average age of cancer development being 29 years.…”

“…[ 5 ] Between 2% and 15% of cases can present the coexistence of adenomas and adenocarcinomas, in addition to juvenile polyps. [ 6 ] Hereditary polyposis syndromes represent another important clinical context that should be taken under consideration by every physician in order to properly evaluate a patient with polyps. [ 6 ] Among these hereditary conditions, we recall familial adenomatous polyps which are usually asymptomatic during the first decade of life, the condition being characterized by >100 adenomatous colonic polyps involving the entire gastrointestinal tract.…”

“…[ 6 ] Hereditary polyposis syndromes represent another important clinical context that should be taken under consideration by every physician in order to properly evaluate a patient with polyps. [ 6 ] Among these hereditary conditions, we recall familial adenomatous polyps which are usually asymptomatic during the first decade of life, the condition being characterized by >100 adenomatous colonic polyps involving the entire gastrointestinal tract. [ 7 ] Another hereditary polyposis syndrome worth mentioning is the Peutz–Jeghers syndrome, a rare inherited autosomal dominant condition defined by the association between mucocutaneous pigmentation, hamartomatous polyposis, and a high risk of cancer development.…”