How Much Harder is a Colonoscopy in Children Less Than 6 Years of Age

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R Bolia et al. JPGN 2023; 77: 396-400. Characterization of Colonoscopies in Preschool Children

In this retrospective review, among 1671 colonoscopies (2014-2020), 13% (n=219) were in children less than 6 year of age (Median 3.9 yrs). Key findings:

  • Most common indications in preschoolers were rectal bleeding 35% (n = 78), inflammatory bowel disease 24% (n = 53), diarrhea 13% (n = 30), iron-deficiency anemia 11% (n = 25), and abdominal pain 7% (n = 16).
  • Ileal intubation rate (IIR) and cecal intubation rate (CIR) were lower in preschoolers (2 to <6 yrs) compared to older children, 81% vs 92% (P = 0.0001), and 93% vs 96.4% (P = 0.02), respectively, and even lower in those aged <2 years, 48.1% IIR (P = 0.0001) and 85.1% CIR. 
  • Diagnostic yield was highest for rectal bleeding at 41% (32/78) including juvenile polyps in 27. The diagnostic yield was 37% for those with diarrhea (12/30) and 36% (9/25) for those with iron deficiency anemia. Overall, diagnostic yield was 40% (87/219)
  • 10 patients (5% of total and 11.5% of those with abnormalities) had findings limited to right colon and/or ileum; thus, incomplete evaluation would have missed these findings.

The authors suggest modifying the PEnQuIN goal of IIR >/= 85% in young children. However, this is unnecessary as most endoscopists are not separating their cases by age.

My take: This study shows that colonoscopy is often more difficult to complete in younger children. Achieving high IIR improves the yield of colonoscopy. Overall, the findings in this report mirror our experience in which colonoscopy had a diagnostic yield of 42% (in non-folllowup colonoscopies) and findings isolated to ileum were noted in 6% (and additional 4% with grossly normal/abnormal histology).

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