| Background and objectiveColonic polyp is a kind of common disease in pediatrics and a kind of common cause of pediatric hematochezia. With the wide use of colonoscopy, the detection rate of colonic polyps in children is greatly enhanced. Colonic polyps include juvenile polyps, adenomatous polyps and so on. Juvenile polyp is the most common pediatric polyps and may have a slightly lower cancer risk. Several studies have stress that cancer risk can increase when adenomas occur in inner part of solitary. Hyperplastic polyps, adenomatous polyps and Peutz-Jeghers polyps are rare in children. Adenomatous polyp is considered as precancerous lesions, while Juvenile polyps and Peutz-Jeghers polyps are genetic diseases with a high risk of multi-organ malignancies. Therefore, early diagnosis and treatment of colonic polyps are very important.Rectal touch, colonoscopy or double-contrast barium enema are common methods in diagnosis. Rectal touch can only be used to examine the rectum polyps near the anus. Barium enema can be used to examine the entire colon, but it costs long time, has radiated damage and higher missed rate. Colonoscopy is the preferred method for the detection and removal of colon polyps, and it is considered as the gold standard by most. However, it has some disadvantages, such as trauma, injury or perforation of the intestinal wall, and poor tolerance. Thus, it has some restrictions in clinical. It is necessary to explore a kind of non-invasive method in diagnosis. CTVC and MRVC are non-invasive methods carried out in recent years.CTVC can found more than 0.5 cm polyps in diameter and scan the entire colon, and is a reliable means. Air is required to be poured through a rectal enema tube to make patients maximum tolerance before examination. However, children have less air resistance and the cost of inspection is high. Thus, CTVC is difficult to become a routine examination method. MRVC has good imaging quality. It only emphasizes the full bowel preparation at the outset, but also requires the contrast agent within the intestine full of the entire colon as possible. In the check, a single scan only display cavity situation without the intestinal wall and outside tissue. Children have difficulty in breath-hold, and the MRVC examination need high cost. Thus, MRVC is difficult widely used in clinical. Therefore, it is very important to explore new diagnostic techniques and methods for the diagnosis of colonic polyps in children. Ultrasonography has been widely used in clinical practice, with no radiated damage, no-trauma, painless, short time, cheap and secure and needs no special preparation or special contrast agents. But the application in pediatric colonic polyps did not attract enough attention. Several studies so far have stressed the value of gray-scale sonography after bowel cleansing and colon filling with water or saline in the diagnosis of juvenile polyps in children. In this study, colonoscopy is the diagnostic gold standard for colon polyps in children, and the routine procedure for abdominal sonography starts with a general examination of the abdomen and includes examination of the intestine. A linear high frequency transducer is mainly used for the general examination of the abdomen with graded compression gray-scale and color doppler sonography. The part of the rectum and sigmoid colon located deep in the pelvic cavity is then scanned with colon filling with water or saline, and the last segment of the rectum is scanned by probe placed directly on the anus with the sagittal and coronal section. This study is to broaden the range of ultrasonography, to explore the value in diagnosis, to improve the ultrasound diagnosis rate of colonic polyps in children, and to provide imaging evidence for diagnosis and treatment of colonic polyps in children.Materials and methods1. Patients dataFrom February 2008 to December 2010, a prospective study was performed in 46 patients. It included 27 males and 19 females, ranging in age from 8 months to 9 years,7 cases were<3 years,33(71.74%) cases were 3-6 years,6 cases were> 6 years. The clinical presentations were hematochezia, abdominal pain and vomiting.2. Ultrasonic scanningThe sonographic equipments were Phillips HDI 5000 and iU22 ultrasonography system with a high frequency 5-12 MHz transducer and a convex 1-5 MHz transducer. Sonographic examination was performed following bowel cleansing by enema with graded compression. Examination of the colon started at the cecum and ileocecal valve and extended to the ascending, transverse, descending colon, sigmoid flexure and the rectum. The rectum and the distal portion of the sigmoid flexure located deep in relation to the abdominal cavity were started after saline enema. For the last segment of the rectum, transducer was placed in anal with the sagittal section, coronal section to scan. When polyps were detected, their location, size, shape, interior echo and root were recorded. After removal, all polyps were sent for pathologic examination.3. Statistical analysisAll statistics were calculated with SPSS 11.5. A significant difference was considered when the P value was less than 0.05. According to diameter, all of the polyps were divided into 3 groups:≤1cm, 1-3cm and≥3cm, the sensitivity of every group was calculated and analysed.Results1. On sonography and colonoscopy48 polyps (46 patients) were detected with colonoscopy.43 patients were detected with Ultrasonography. The distribution of the polyps size were as follows:7 polyps were≤1 cm in diameter,38 polyps were 1 to 3 cm, and 3 polyps were> 3 cm. The smallest polyp was 0.73x0.68cm, the largest one was 3.65×2.34cm.38 polyps were detected by routine ultrasound,6 polyps after the saline enema. Compared with colonoscopy, ultrasonography missed 3 patients and 4 polyps, of which 3 polyps was in<1cm in diameter and 1 polyps was 1.60cm.2. The overall sensitivity was 91.67% for ultrasound detected polyps,57.14% for lesions smaller than 1 cm,97.37% for lesions between 1 cm and 3 cm, and 100% for lesion larger than 3 cm. The group of≤1cm in diameter compared with the other two, (1cm～3cm group and≥3cm group), has the significant differences (P<0.01). 1cm～3cm group compared with≥3cm group has no significant differences (P>0.05).3. On pathologic examinationOf the 46 patients,44(95.65%) had juvenile polyps,1 had adenomatous polyps, and 1 had Peutz-Jeghers polyps.ConclusionThe sonographic imagings of colonic polyps have special characteristics in children.Ultrasonography obtains a high sensitivity in polyp size in≥1cm. It is the easiest method to diagnose colonic polyps and can be used for the screening and follow-up of colonic polyps in children. |
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