Gastrointestinal Polyps and Polyposis in Children: Experience of Endoscopic and Surgical Outcomes

Introduction: There are gaps in literature regarding outcome of multiple polyps and dilemmas in the management issues in polyposis syndromes in children.

Objective: We aimed to study the clinical behaviour of gastrointestinal (GI) polyps with emphasis on therapeutic outcomes of polyposis syndrome.

Methods: Proven cases of GI polyp(s) on endoscopy were classified as, single polyp, multiple polyps and polyposis syndrome. Complex presentation was defined as one or more of the following: severe anemia, anasarca, intussusception, rectal mucosal prolapse, diarrhea. A clinico-endoscopic criteria was applied in polyposis syndrome patients for the decision of surgery versus endoscopic therapy with surveillance.

Results: Of total 240 patients, there were no significant differences between single (52.5%, n=126) vs. multiple polyps (27.5%, n=66) with respect to age, symptoms, histology and recurrence. Polyposis syndrome (20%, n=48) presented with complex symptoms (50%), higher family history, significantly lower hemoglobin, total protein and albumin as compared to single and multiple polyps (p<0.01). 19 polyposis patients with favourable clinico-endoscopic criteria were endoscopically eradicated for polyps in 3 (1-4) sessions with sustenance of laboratory parameters at 1 year and 30% symptomatic recurrence at follow-up of 23.5 (7-40) months. There were no major endoscopic complications. 19 patients required proctocolectomy with improvement in laboratory parameters 6 months post-surgery.

Conclusions: Multiple polyps behave similar to single polyps in children. A clinico-endoscopic criteria may guide for optimal management of polyposis syndrome. Colectomy may be effectively deferred in a large proportion of polyposis syndrome patients if maintained on an endoscopic protocol.