Clarke Glen, Robb Andrew, Sugarman Ian, McCallion William A
Royal Belfast Hospital for Sick Children, BT12 6BE, Belfast, Northern Ireland, UK.
J Pediatr Surg. 2005 Dec;40(12):1920-2. doi: 10.1016/j.jpedsurg.2005.08.007.
Most patients with recurrent painless rectal bleeding warrant endoscopic examination of the lower gastrointestinal tract. This is often limited to rectum or distal colon. The purpose of this study was to compare the diagnostic yield of limited colorectal endoscopy with total colonoscopy in children with recurrent painless rectal bleeding.
Retrospective review of 314 patients aged 1 to 15 years who underwent colorectal endoscopy for recurrent rectal bleeding. Two hundred six underwent total colonoscopy, whereas 108 patients had endoscopy limited to the rectum in 22, sigmoid colon in 34, descending colon in 43, and transverse colon in 9. Diagnoses were recorded according to the endoscopic and histological findings.
After total colonoscopy, a diagnosis was established in 70% of children compared with 35% of those undergoing limited endoscopy (P < .001). This difference was most noticeable in children with inflammatory bowel disease. Juvenile polyps were diagnosed with similar frequency in both groups, reflecting the rectosigmoid distribution of most polyps.
For children presenting with painless rectal bleeding, a diagnosis can be established in the majority if total colonoscopy is performed. This is particularly true for inflammatory bowel disease. Unless a rectal polyp is suspected, full colonoscopy should be planned.
大多数复发性无痛性直肠出血的患者需要接受下消化道内镜检查。检查通常局限于直肠或结肠远端。本研究的目的是比较有限的大肠内镜检查与全结肠镜检查对复发性无痛性直肠出血儿童的诊断率。
回顾性分析314例年龄在1至15岁因复发性直肠出血接受大肠内镜检查的患者。206例行全结肠镜检查，而108例患者的内镜检查局限于直肠（22例）、乙状结肠（34例）、降结肠（43例）和横结肠（9例）。根据内镜和组织学检查结果记录诊断。
全结肠镜检查后，70%的儿童确诊，而接受有限内镜检查的儿童确诊率为35%（P <.001）。这种差异在炎症性肠病患儿中最为明显。两组中幼年息肉的诊断频率相似，这反映了大多数息肉的直肠乙状结肠分布。
对于出现无痛性直肠出血的儿童，如果进行全结肠镜检查，大多数患者可以确诊。炎症性肠病尤其如此。除非怀疑有直肠息肉，否则应计划进行全结肠镜检查。
