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Solitary Juvenile Polyp
Solitary Juvenile Polyp J Pohl, Dr.-Horst-Schmidt-Klinik, Wiesbaden, Germany r 2013 Elsevier GmbH. All rights reserved. Received 13 March 2012; Revision submitted 13 March 2012; Accepted 1 April 2012
Abstract Juvenile polyps are one of the most common sources of gastrointestinal bleeding in childhood. These polyps are nonneoplastic hamartomas that occur in up to 2% of children. The author presents the case of an 8-year-old boy with recurrent rectal bleeding due to a singular juvenile polyp. This article is part of an expert video encyclopedia.
Keywords Bleeding; Pediatric endoscopy; Polypectomy; Standard endoscopy; Video.
Video Related to this Article Video available to view or download at doi:10.1016/S22120971(13)70183-3
Technique
that ranges from 10% to 50%.2 Solitary juvenile polyps and polyposis are distinguished by the number of polyps encountered. A diagnosis of FJP is made when more than three juvenile polyps are encountered. The author presents the case of an 8-year-old boy with recurrent rectal bleeding due to a singular juvenile polyp. After diagnosis, the polyp was resected to prevent recurrent bleeding.
Colonoscopy.
Key Learning Points/Tips and Tricks Materials
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Colonoscopy: EC 530WI; Fujifilm, Tokyo, Japan. Injection needle: Olympus, Tokyo, Japan. Polypectomy snare: Cook Medical, Winston-Salem, NC, USA. Generator: ERBE VIO generator, Tu¨bingen, Germany.
Background and Endoscopic Procedure Solitary juvenile polyps are among the most common causes of rectal bleeding in childhood.1 Indeed, the presence of isolated juvenile polyps in children who are under 10 years of age is relatively common, occurring in up to 2% of children. However, the term ‘juvenile’ refers to the type of polyp rather than to age of onset of these polyps. These polyps are nonneoplastic hamartomatous polyps that histologically contain dilated cystic spaces, inflammation, increased vascularity, and areas of epithelial destruction. They are found most often in the rectosigmoid, but may be multiple and scattered throughout the colon. On colonoscopy, polyps are typically 1–3 cm in size, have a smooth and reddish polyp head, and bleed easily. It is of utmost importance to distinguish patients with solitary hamartoma from patients with multiple or recurrent juvenile polyps who may have familial juvenile polyposis (FJP). This is an autosomal-dominant genetic disorder that confers an increased risk of adenoma and colon cancer This article is part of an expert video encyclopedia. Click here for the full Table of Contents.
Video Journal and Encyclopedia of GI Endoscopy
Solitary juvenile polyps are among the most common causes of rectal bleeding in childhood. Polypectomy of juvenile polyps is indicated to confirm the diagnosis and prevent recurrent bleeding.
Scripted Voiceover Here we perform colonoscopy in an 8 year old boy with recurrent rectal bleeding. Right here, 4 cm above the anal verge, we see this pedunculated bright red polyp. This polyp has the typical appearance of a juvenile polyp: they are usually 1–3 cm in size, smooth and reddish and bleed easily due to erosions within the polyp head. Note that the mucosal structure is clearly different from the gyriforme structure of an adenoma. Virtual chromoendoscopy with FICE (speak: fice) enhances visualization of the mucosal blood vessels within the polyp head. The thick stalk of the polyp shows pronounced lymphatic vessels. These appear as small white dots and gyrifrom tubular structures. This phenomenon is probably caused by the chronic traction that is exerted by the heavy polyp head. In a next step, the polyp is lifted by submucosal injection of diluted epinephrine. Now we can easily resect the polyp with a 1 cm standard snare. To minimize thermal damage to the bowel wall, make sure that the polyp is slightly lifted into the lumen during resection.
References 1. Perisic, V. N. Colorectal Polyps: An Important Cause of Rectal Bleeding. Arch. Dis. Child 1987, 62, 188–189. 2. Howe, J. R.; Roth, S.; Ringold, J. C.; et al. Mutations in the SMAD4/DPC4 Gene in Juvenile Polyposis. Science 1998, 280, 1086–1088.
http://dx.doi.org/10.1016/S2212-0971(13)70183-3
410
Abstract Juvenile polyps are one of the most common sources of gastrointestinal bleeding in childhood. These polyps are nonneoplastic hamartomas that occur in up to 2% of children. The author presents the case of an 8-year-old boy with recurrent rectal bleeding due to a singular juvenile polyp. This article is part of an expert video encyclopedia.
Keywords Bleeding; Pediatric endoscopy; Polypectomy; Standard endoscopy; Video.
Video Related to this Article Video available to view or download at doi:10.1016/S22120971(13)70183-3
Technique
that ranges from 10% to 50%.2 Solitary juvenile polyps and polyposis are distinguished by the number of polyps encountered. A diagnosis of FJP is made when more than three juvenile polyps are encountered. The author presents the case of an 8-year-old boy with recurrent rectal bleeding due to a singular juvenile polyp. After diagnosis, the polyp was resected to prevent recurrent bleeding.
Colonoscopy.
Key Learning Points/Tips and Tricks Materials
•
• • •
•
•
Colonoscopy: EC 530WI; Fujifilm, Tokyo, Japan. Injection needle: Olympus, Tokyo, Japan. Polypectomy snare: Cook Medical, Winston-Salem, NC, USA. Generator: ERBE VIO generator, Tu¨bingen, Germany.
Background and Endoscopic Procedure Solitary juvenile polyps are among the most common causes of rectal bleeding in childhood.1 Indeed, the presence of isolated juvenile polyps in children who are under 10 years of age is relatively common, occurring in up to 2% of children. However, the term ‘juvenile’ refers to the type of polyp rather than to age of onset of these polyps. These polyps are nonneoplastic hamartomatous polyps that histologically contain dilated cystic spaces, inflammation, increased vascularity, and areas of epithelial destruction. They are found most often in the rectosigmoid, but may be multiple and scattered throughout the colon. On colonoscopy, polyps are typically 1–3 cm in size, have a smooth and reddish polyp head, and bleed easily. It is of utmost importance to distinguish patients with solitary hamartoma from patients with multiple or recurrent juvenile polyps who may have familial juvenile polyposis (FJP). This is an autosomal-dominant genetic disorder that confers an increased risk of adenoma and colon cancer This article is part of an expert video encyclopedia. Click here for the full Table of Contents.
Video Journal and Encyclopedia of GI Endoscopy
Solitary juvenile polyps are among the most common causes of rectal bleeding in childhood. Polypectomy of juvenile polyps is indicated to confirm the diagnosis and prevent recurrent bleeding.
Scripted Voiceover Here we perform colonoscopy in an 8 year old boy with recurrent rectal bleeding. Right here, 4 cm above the anal verge, we see this pedunculated bright red polyp. This polyp has the typical appearance of a juvenile polyp: they are usually 1–3 cm in size, smooth and reddish and bleed easily due to erosions within the polyp head. Note that the mucosal structure is clearly different from the gyriforme structure of an adenoma. Virtual chromoendoscopy with FICE (speak: fice) enhances visualization of the mucosal blood vessels within the polyp head. The thick stalk of the polyp shows pronounced lymphatic vessels. These appear as small white dots and gyrifrom tubular structures. This phenomenon is probably caused by the chronic traction that is exerted by the heavy polyp head. In a next step, the polyp is lifted by submucosal injection of diluted epinephrine. Now we can easily resect the polyp with a 1 cm standard snare. To minimize thermal damage to the bowel wall, make sure that the polyp is slightly lifted into the lumen during resection.
References 1. Perisic, V. N. Colorectal Polyps: An Important Cause of Rectal Bleeding. Arch. Dis. Child 1987, 62, 188–189. 2. Howe, J. R.; Roth, S.; Ringold, J. C.; et al. Mutations in the SMAD4/DPC4 Gene in Juvenile Polyposis. Science 1998, 280, 1086–1088.
http://dx.doi.org/10.1016/S2212-0971(13)70183-3
410