La coloscopie chez l’enfant, étude critique : indications, préparation et résultats

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AuteurMaatallaoui M
EncadrantLakhdar idrissi M

Colonoscopy has become a fundamental and sensitive examination in the diagnosis and treatment of the child’s diseases colon.
In our study, we reported the experience of the Pediatric Service (digestive explorations) – CHU Hassan II Fez, involving 43 patients who underwent 50 colonoscopies, compiled from the register of colonoscopies, for a 2 years period (from 1st January 2013 to 31 December 2014). The objectives of this study were to:
– Report and analyze the main indications for colonoscopy in pediatric;
– Criticize the quality of bowel preparation, and its influence on the exploration, the results, and the therapeutic procedure (polypectomy);
– Analyze of the results obtained compared with the indications;
– Establish recommendations on: o The indications which must not be unreasonable; o The best way of bowel preparation appropriate to the different ages of the child. Annual average of colonoscopies is 25 exams/year.
The age of the patients in our series varies between 3 years and 16 years with an average age of 8 years. Sex male / female ratio is 1.68.
The indications are varied; rectal bleeding is the most frequent indication 62%, chronic abdominal pain 12%, chronic diarrhea 8%, and prolapsed mass through anus 2%. The realization of a safe and effective colonoscopy requires good bowel preparation. For 35 patients, the bowel preparation is made using with enemas spillways (Normacol enema) associated to the PEG, the remaining 8 patients were prepared by the Normacol enema alone. However dietary preparation by residue diethasn’t been followed by any patient. Almost the majority of well prepared colonoscopy is the bowel preparation by enema Normacol associated to PEG; indeed, almost the third of colonoscopies with deplorable quality is prepared using the Normacol enema alone.
Of all the acts performed: 14colonoscopies were total (28%). Colonoscopy has reached the transverse colon in 26% of cases, the ascending colon in 20%, the splenic flexure 16%, the hepatic flexure in 4%; this exam has studied the rectosigmoid area only in 6% of cases.
Colonoscopy was normal in 34% of cases. Normal colonoscopies are motivated in half the cases by rectal bleeding, and were in almost 2/3 of cases poorly prepared.
The polyp, often unique, represented 30% of the results. IBD were diagnosed in 20% of cases, non-specific colorectal concerned 10% of cases, pinworm 4% and infectious colitis 2% of cases.
Control colonoscopies are included in our study (8% of indications), 4 explorations on 50 colonoscopies were made in patients pursued for inflammatory bowel disease (Crohn’s Disease or Ulcerative Colitis) Endoscopic polypectomy is the only interventional procedure performed in our service, 21 polyps were diagnosed in 14 patients, including 3 witch haven’t been resected: 2 polyps in the same patient with deplorable bowel preparation, and 1polyp in another patient because of his small size.
No serious accidents have been described. Three patients had presented a moderate bleeding in the end of exploration: 2 after polypectomy and 1 after biopsy. However, we didn’t need to put hemostatic clips in any case.