Rectal bleeding in children: endoscopic evaluation revisited.
OBJECTIVE
Rectal bleeding is an alarming event both for the child and parents. It is hypothesized that colonoscopy instead of sigmoidoscopy and adding esophago-gastro-duodenoscopy in case of accompanying complaints, improves the diagnostic accuracy in children with prolonged rectal bleeding.


METHODS
All pediatric patients undergoing colonoscopy because of prolonged rectal bleeding over an 8-year period at the Emma Children's Hospital/Academic Medical Centre were reviewed. Patient demographics, clinical features, number and extent of endoscopic examinations and the endoscopic and histopathological findings were assessed.


RESULTS
A total of 147 colonoscopies were performed in 137 pediatric patients (63 boys) because of prolonged rectal bleeding. Inflammatory bowel disease and polyp(s) were the most prevalent diagnoses. In 72% of patients diagnosed as Crohn's disease, focal, chronically active gastritis was seen on histology, giving support to the diagnosis Crohn's disease. In 22% of the cases polyps would have been missed in the case where only sigmoidoscopy was performed. No complications after endoscopic intervention were seen.


CONCLUSIONS
Colonoscopy is the investigation of choice in children with prolonged rectal bleeding. In patients presenting with accompanying complaints such as abdominal pain or diarrhea, it is advisable to perform ileocolonoscopy combined with esophago-gastro-duodenoscopy. This combines a high diagnostic yield with a safe procedure.
de Ridder
Lissy
L
Department of Pediatric Gastroenterology, VU University Medical Centre, Amsterdam, The Netherlands. l.deridder@vumc.nl
van Lingen
Anna V
AV
Taminiau
Jan A J M
JA
Benninga
Marc A
MA
D015746:Abdominal Pain / Q000209:etiology / Q000473:pathology; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003113:Colonoscopy; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000209:etiology / Q000473:pathology; D004384:Duodenoscopy; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004945:Esophagoscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000473:pathology*; D005773:Gastroscopy; D006801:Humans; D007223:Infant; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000473:pathology; D007417:Intestinal Polyps / Q000150:complications / Q000473:pathology; D008297:Male; D012007:Rectum; D012189:Retrospective Studies