Last week, a 7 year old with a 6 month history of loose stools and rectal bleeding underwent a panendoscopy.  Prior to endoscopy, she had a calprotectin level of 1000 mcg/gram.

• Findings: Huge (>5 cm) multilobulated polyp which was removed at stalk.  A second pass to revise stalk was completed subsequently. The histology report noted that the polyp was a benign juvenile polyp.

This case was interesting to me due to the unusual size/configuration of the polyp and the very elevated calprotectin.  I was aware of elevated calprotectin levels with polyposis (in part from a recent review of our experience with ~400 colonoscopies in our center: Full Text Link: Diagnostic Yield Variation with Colonoscopy among Pediatric Endoscopists)

Two views of large polyp from scope in descending colon

Related blog posts:

• Surprising Genetic Mutations in Polyposis Study
• Our Study: Provider Level Variability in ColonoscopyYield Reference: Olafsdottir I, et al. Value of Fecal Calprotectin as a Biomarker for Juvenile Polyps in Children Investigated With Colonoscopy. J Pediatr Gastroenterol Nutr. 2016 Jan;62(1):43–6.)
• Review: Polyposis in Pediatrics
• What I Like About ESPGHAN Familial Adenomatous Polyposis Guidelines These recommendations, however, suggest starting screening at 12-14 years.
• ESPGHAN Juvenile Polyposis Syndrome Recommendations  These recommendations are different in that they do not recommend EGD in the pediatric age group: “Surveillance of the upper GI tract in affected or at-risk JPS patients is not required in childhood or teenage years, unless there is unexplained anaemia or upper GI symptoms.”
• ESPGHAN Peutz-Jeghers syndrome Guidelines
• Are You Familiar with CMMR-D? The term CMMR-D refers to constitutional mismatch repair deficiency.  This occurs when an individual inherits two MMR gene defects (rather than one gene defect in Lynch syndrome); with CMMR-D screening recommendations include yearly endoscopic evaluation beginning at age 3 years or at diagnosis.
• Updated Guidelines on Genetic Testing/management for Hereditary GI Cancer Syndromes
• Update for Peutz-Jegher Syndrome
• Screenshots: Peutz-Jeghers Syndrome, Alcohol #1 for Liver Transplantation, Case report Fanconi Syndrome due to Tenofovir Alafenamid