A recent retrospective study (N Ibrahimi et al. JPGN 2019; 69: 668-72) reviewed juvenile polyp characteristics over a 14 year period (2003-17) from 213 pediatric subjects who underwent 326 procedures.  The authors state their review was intended for nonsyndromic juvenile polyps, though 23 of the patients had ≥5 polyps (which is incongruous with their presented methods of including children with less than 5 polyps).

Key findings:

• The authors state that polyp recurrence rates on repeat colonoscopy were 1.5% if one polyp, 19.2% if 2-4 polyps, and 82.6% if 5-10 polyps
• Juvenile polyps harbored adenomatous changes in 26 (12%) of patients
• The presence of adenomatous changes did not correlate with polyp number; however, a polyp on the right-sided was more likely to harbor adenomatous changes

It is possible that some of the ‘recurrent’ polyps were missed polyps, as polyps can be easily overlooked.  I had a recent experience of removing numerous polyps (14) from a child recently and some were identified in part due repeated visualization of several colonic segments.  The recent ESPGHAN position paper is useful in children with multiple polyps; their recommendations include: In a child with a single JP, a repeat colonoscopy is not routinely required. (Weak recommendation, very low quality of evidence).

My take: This report is notable for the following:

1. a fairly high rate of adenomatous changes in juvenile polyps.
2. a high recurrence rate for children with multiple polyps

Related blog posts:

• ESPGHAN Juvenile Polyposis Position Paper
• While the polyps described are not tubular adenomatous polyps, it is noted that guidelines in adults recommend followup in 5-10 years for a single (non-serrated) adenomatous polyp (Polyps: Clinical Decision Tool).
• Updated Guidelines on Genetic Testing/management for Hereditary GI Cancer Syndromes
• Surprising Genetic Mutations in Polyposis Study
• Polyposis in Pediatric Patients -Review
• Consensus guidelines after polypectomy | gutsandgrowth)
• Adenoma Detection Rate: Life or Death Quality Measure

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