Clinicopathological Features,diagnosis And Treatment Of Colorectal Juvenile Polyps

Objective: To investigate the clinical,endoscopic and pathological features of colorectal juvenile polyps(JP)in patients of different ages,and to summarize the experience of single-center diagnosis and treatment,in order to improve clinicians’ understanding and diagnosis of JP,and to provide a reference basis for disease management of colorectal JP.Methods: 111 all-age patients hospitalized with a diagnosis of colorectal JP in the database of the Department of Pathology,Second Hospital of Lanzhou University between January 2013 and December 2022 were included,and clinical data such as general data,clinical manifestations,laboratory and imaging findings,colonoscopic manifestations,pathological features,treatment modalities and complications were collected for retrospective analysis.Results: Among the 111 colorectal JP patients,76(68.5%)were children and 35(31.5%)were adults,all of whom were predominantly male.The median age of the children group was 5 years,with the highest proportion of patients(41.6%)in the preschool age(3～6 years),and the mean age of the adult group was 44±13 years.Intermittent hematochezia was the most common symptom in patients with colorectal JP,accounting for 82.0% of the total number of cases.Two children had secondary intussusception,and there were statistical differences in the clinical manifestations of patients in different age groups.Anemia occurred in 13 patients(11.7%)and 0.9%(1/111)were severely anemic.There were no statistically significant differences in age,duration of disease,number,size and morphology of polyps between the anaemic and normal groups of patients,while the incidence of anaemia was significantly lower in children with rectal polyps than in children with sigmoid,descending and transverse colon polyps.Patients with solitary and multiple polyps accounted for94.6% and 5.4%,respectively.Rectum was the most common site of JP(56.4%),followed by sigmoid colon(26.4%),and 10.9% of patients had polyps distributed in the proximal colon.The majority of polyps were 1 cm to 2 cm in diameter(51.4%),and 93.5% were pedunculated or semipedunculated.The chicken skin mucosa observed under endoscopy was more common around large polyps and giant polyps in the distal colon.low-grade intraepithelial neoplasia occurred in the polyps of 6(5.4%)JP patients.Endoscopic polypectomy for colorectal JP was safe and effective.Follow-up results were obtained in 83.8% of patients,with no recurrence in 1 case during the follow-up period of 0.2 to 10.1 years.Conclusion: JP is the most common pathological type of colorectal polyps in children,which mainly occurs in preschool age and is predominantly male,while adult colorectal JP is rare,and there are differences in the clinical features between children and adult JP patients.Colonoscopy is the preferred method for diagnosis and treatment of JP.A few patients had complications such as anemia and intussusception,and some JP could develop intraepithelial neoplasia,which requires clinical attention.All lesions should be removed early if safe and feasible,and a review and follow-up plan should be formulated according to the postoperative pathological results.