Quality indicators for colonoscopy in pre-schoolers may need to be different from older children because of different disease prevalence

Abstract

Objectives and Study: Quality indicators for colonoscopy in adults are well established, and mainly target colorectal cancer screening as it is by far the most common indication. In contrast, the most common indication for colonoscopy in children is for diagnosis or review of inflammatory bowel disease (IBD). High rate of ileal intubation has been proposed as a more meaningful quality indicator in paediatric colonoscopy. Whether this also applies to very young children is unclear since there is very limited information on colonoscopy in this age group. IBD is less likely in the very young, and they would potentially, by virtue of their small size, have a greater risk of adverse events if ileal intubation is mandated. Our study aims therefore were to assess the indications for colonoscopy in pre-school children aged < 6years, and whether high rates of caecal and ileal intubation are achievable. Methods: Retrospective review of all colonoscopy procedures performed in a tertiary paediatric hospital between Dec 1, 2014 until Nov 30, 2018 was undertaken. Only children aged < 6 years, designated pre-schoolers, were included in this review. Demographic factors, indication for colonoscopy, extent of colonoscopy, and histologic findings were noted. Caecal and ileal intubation were noted and compared to the whole cohort. Colonoscopy was considered incomplete if caecal intubation was not achieved. Results: 1085 total colonoscopies were performed at our centre during the four-year study period, with median age 12.22 (range 0.33-19.48) years. Of these, 13% (143/1085) were performed in children aged < 6years; median age 4.07 (range 0.33-5.95) years, and weight 15.75 (range 6.2-24.4) kg. Most common indications for colonoscopy in pre-school children were rectal bleeding 36% (52/143), potential or follow up IBD 21% (30/143), iron deficiency anemia 13% (19/143), diarrhea 8% (11/143) and pain 7% (10/143). 1 patient had colonoscopy to perform faecal microbial transplant. Incomplete colonoscopy was more likely in pre-schoolers, 8% (12/143) compared to the whole cohort 4% (39/1085, p= 0.013). Ileal intubation rate (IIR) and caecal intubation rate (CIR) were also lower in pre-schoolers compared to whole cohort, 76% vs 88% (p=0.001) and 92% vs 96% (P=0.013) respectively. Positive findings were found in 31% (44/143), of which juvenile polyps 43% (19/44) was most common, followed closely by IBD 41% (18/44). Other findings include perianal disease (n=2), eosinophilia (n=2), lymphocytic colitis (n=2) and 1 with vascular ectasia. Conclusion: Rectal bleeding is the most common indication for colonoscopy in pre-school children with juvenile polyps the most common positive finding. High rates of CIR and IIR are achievable in preschool children, albeit at slightly lower rate than in older children, but may not be as essential since IBD is less common in this age group.L6351738202021-06-08 <br />