Saudi Journal of Gastroenterology
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Year : 1999  |  Volume : 5  |  Issue : 3  |  Page : 120-123
Pediatric colonoscopy: King Khalid University Hospital Experience


Department of Medicine, College of Medicine & KKUH King Saud University, Riyadh, Saudi Arabia

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Date of Submission02-Jul-1997
Date of Acceptance14-Apr-1999
 

   Abstract 

Pediatric colonoscopy is now an established procedure to evaluate colonic disease. As there is no reports about pediatric colonoscopy in our community a retrospective study was carried in KKUH to analyze the pediatric colonoscopies. This is a retrospective study over 15 years period in KKUH to analyze the pediatric colonoscopy. Sixty-six colonoscopies were done in sixty-two patients. The age ranged from 6 month to 16 years; with 35 males and 27 females. Forty-seven of the patients were Saudi. Indication for colonoscopy were bleeding per rectum thirty-two, diarrhea ten, abdominal pain seven, ulcerative colitis in four, suspected polyps in five and other indication in seven patients. In 33 patients colonoscopy was done without premedication, 11 patient had sedation while 22 had general anesthesia. Colonoscopy revealed abnormal finding in 64%, normal findings 28.7% and due to poor preparation no endoscopic report in 7.3%. The commonest abnormal finding were ulcerative colitis in 19 patients and polyps in 17 patients. Pediatric colonoscopy is a safe, practical rewarding procedure especially in certain categories of patients mainly those suspected to have ulcerative colitis, rectal bleeding or diarrhea. A high index of suspicion of ulcerative colitis will lead to better management of patients.

How to cite this article:
Al Rashed RS. Pediatric colonoscopy: King Khalid University Hospital Experience. Saudi J Gastroenterol 1999;5:120-3

How to cite this URL:
Al Rashed RS. Pediatric colonoscopy: King Khalid University Hospital Experience. Saudi J Gastroenterol [serial online] 1999 [cited 2019 Nov 12];5:120-3. Available from: http://www.saudijgastro.com/text.asp?1999/5/3/120/33531


Endoscopical procedures are routinely utilized in evaluation of gastrointestinal symptoms in adults. In pediatric patients upper gastrointestinal endoscopy and colonoscopy may provide essential information for diagnosis and management [1] . In-patients in whose gastrointestinal symptoms can be attributed to colonic disease one must decide on its proper evaluation. The colon radiography, although a safe and valuable procedure, provides only indirect evidence of disease. Conversely colonoscopy affords the ability to directly visualize and obtain biopsies from any area in the entire colon and avoids the hazards of radiation in children. Colonoscopy has become a safe and effective diagnostic procedure and very sensitive in detection of colonic disease [2]

In Saudi Arabia, upper and lower endoscopy is routinely performed in referral centers in pediatric age group. However their results in pediatric colonoscopy have not been published in the literature. Thus a retrospective analysis of the pediatric colonoscopies done in King Khalid University Hospital was carried out.


   Patient and Method Top


This is a retrospective analysis of the indications and Endoscopical findings of all colonoscopies done over 15 years period (1402 - 1416) in King Khalid University Hospital. Total number of colonoscopy done was 66 in 62 children up to the age of 16 years. Parenteral consent was signed before the procedure. The majority of patients underwent colonoscopy as inpatient. Bowel preparation was either saline lavage till clear bowel motions or cleansing enema or fluid diet. Patients were given either general anesthesia or sedation in 33 patients. Instruments used were fiberoptic adult colonoscopes and the technique used was as for adult colonoscopy.


   Result Top


Sixty-six colonoscopies were performed in sixty-two children. The age ranged from 0.5 to 16 years. Age distribution is shown in [Figure - 1]. There were 35 males and 27 females. Forty-seven of the patients were Saudi while 11 were Arabs and 4 patients from other nationalities.

In thirty-five patients total colonoscopy was performed while 25 patients had partial colonoscopy and five had poor preparation and procedure terminated in one patient without indicating the site of termination. Preparation in 27 patients was by cleansing enema, 22 by saline lavage, 11 had fluid diet and 5 patients the bowel preparation was not recorded.

The indication for colonoscopy were bleeding per rectum in thirty-two patients, chronic diarrhea in ten, chronic recurrent abdominal pain in seven, suspected ulcerative colitis in four, suspected polyps in five. Other indications in seven patients included Hirschsprung 2, melena 1, intussusception 1, fever and vomiting 1. In one patient the indication for colonoscopy was not recorded. Colonoscopy was performed under general anesthesia in 22 patients, with sedation in 11 patients and no premedication was used in 33 patients. The yield of endoscopic diagnosis versus indication is shown in [Table - 1]. Colonoscopy revealed abnormal finding in 64% of patients; normal finding in 28.7% and in 7.3% of the patients no endoscopic findings were reported due to poor preparation. The commonest abnormal colonoscopic finding were ulcerative colitis in 19 patients and polyps in 17 patients.


   Discussion Top


Colonoscopy is an established procedure for investigation of large bowel in infants and children [2],[3] . [Table - 2] and [Table - 3] show indications and contraindications of colonoscopy in infants and children respectively [2],[4] . The major indication for colonoscopy in our patients namely rectal bleeding, diarrhea and abdominal pain is similar to other reports [2],[5],[6] . Ulcerative colitis either known or suspected was the major indication with the diagnosis confirmed by colonoscopy in our patients which is similar to the findings of other authors [5],[6] However, there is a low index of suspicion of ulcerative colitis in our community, which may explain the unsuspected diagnosis of ulcerative colitis in 15 patients. Rectal bleeding was the next important indication in which colonoscopy established the diagnosis. Colonic polyps were the commonest cause of rectal bleeding followed by ulcerative colitis, which is similar to other reports [7],[8],[9] .

Abdominal pain was an unrewarding indication since no abnormality was detected in the majority of our patients. This also has been observed by other authors [6] .

A clean colon is essential for adequate visualization during colonoscopy. Bowel cleansing protocols include purgatives, enemas, intestinal lavage and dietary measures used either singly or in combination. Premedication during colonoscopy vary depending on the experience of the endoscopist. General anesthesia although advocated by some centers [10] is unnecessary and should be avoided except in selected cases. Light sedation is more desirable than general anesthesia since pain serves as a warning to the endoscopist. Successful colonoscopy has been reported without premedication [11] . In our center the three regimens have been used depending on the indication, patient condition and the physicians preference. The variation in preparation and premedication in our patients illustrates the need to tailor them to the age and status of the patient as well as the choice of colonoscopic technique which also has been advocated by Wyllie [3] . Diagnostic endoscopic procedures generally are safe. Complications of colonoscopy are either secondary to the procedure or preparation and sedation as shown in [Table - 4] [1] . No complications were encountered in our patients, which is similar to other reports [1],[2] .

In conclusion pediatric colonoscopy is a safe, practical rewarding procedure especially in certain categories of patients mainly those suspected to have ulcerative colitis, rectal bleeding or diarrhea. In Saudi Arabia, doctors should have a high index of suspicion of ulcerative colitis, which will lead to better management of their patients.

 
   References Top

1.Rothbaum RJ. Complication of Pediatric endoscopy. Gastrointest Enclose Clin N Am 1966;6:445-59.  Back to cited text no. 1    
2. Rossi T. Endoscopic Examination of the colon in infancy and childhood, Pediatric clinics of North America 1988;5:331-56.  Back to cited text no. 2    
3.Wyllie R, Kay MH. Colonoscopy and therapeutic intervention in infants and children. Gastrointest Endosc Clin N Am 1994;4:143-60.  Back to cited text no. 3    
4.Hassal E, Barclay GN, Ament ME. Colonoscopy in childhood. Pediatrics 1984,73:5594-9.  Back to cited text no. 4    
5.Howdle PD, Littlewood JM, Firth J, Losowsky MS. Routine colonoscopy service. Arch of Disease in Childhood 1984;59:790-3.  Back to cited text no. 5    
6.Williams CB, Laage NJ, Campbell CA, Douglas JR,Warker­Smith JA, Booth IW, Harries JT. Total colonoscopy in children. Arch of Disease in Childhood 1982;59:49-53.  Back to cited text no. 6    
7.Latt TT. Nicholl R, Domizio P, Walker-Smith JA, Williams CB. Rectal bleeding and polyps. Arch of Disease in Childhood 1993;69:144-7.  Back to cited text no. 7    
8.Jalilal A, Misra SP, Arvind AS, Kamath PS. Colonoscopic polypectomy in children. J Pediatr Surg 1992:27:1220-2.  Back to cited text no. 8    
9.Bhargava DK, Rai RR, Dasarathy S, Chopra P.Colonoscopy for unexplained lower gastrointestinal intestinal bleeding in a tropical country. Trop Gastroenterol 1995;16:59-63.  Back to cited text no. 9  [PUBMED]  
10.Plucnar BJ, Rossi T. Colonoscopy in infancy and childhood with special regard to patient preparation and examination technique. Endoscopy 1981;13:14-8.  Back to cited text no. 10    
11.Sasaki H, Yaguchi T, Hasegawa K, Hassal, et al. Pediatric colonoscopy Dis Colon Rectum 1981;24:2547-8.  Back to cited text no. 11    

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Correspondence Address:
Rashed Suliman Al Rashed
Department of Medicine, College of Medicine & KKUH, King Saud University, P.O. Box 2925 (38), Riyadh 11461
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


PMID: 19864736

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