J Korean Med Sci.  2022 Mar;37(9):e72. 10.3346/jkms.2022.37.e72.

Potential Utility of Fecal Calprotectin in Discriminating Colorectal Polyps From Other Major Etiologies in Children Presenting With Isolated Hematochezia

Affiliations
  • 1Department of Pediatrics, Ajou University Medical Center, Suwon, Korea
  • 2Department of Pediatrics, Eulji University Hospital, Daejeon, Korea
  • 3Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
  • 4Department of Pediatrics, Chungnam National University Hospital, Daejeon, Korea
  • 5Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
  • 6Department of Pediatrics, Korea University Anam Hospital, Seoul, Korea
  • 7Department of Pediatrics, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
  • 8Department of Pediatrics, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
  • 9Department of Pediatrics, Hallym University College of Medicine, Chuncheon, Korea
  • 10Department of Pediatrics, Jeonbuk National University Medical School and Hospital, Jeonju, Korea
  • 11Department of Pediatrics, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
  • 12Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju, Korea
  • 13Department of Pediatrics, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea
  • 14Department of Pediatrics, Inje University Ilsan Paik Hospital, Goyang, Korea

Abstract

Background
Colorectal polyps are the most common cause of isolated hematochezia in children, which requires a colonoscopy for diagnosis. We aimed to investigate the potential utility of fecal calprotectin (FC) in assessing colorectal polyps detected by colonoscopy among children presenting with isolated hematochezia.
Methods
Pediatric patients of the age of < 18 years who had undergone both colonoscopy and FC tests for isolated hematochezia from June 2016 to May 2020 were included in the present multicenter, retrospective, cross-sectional study. Comparative analysis was conducted between major causes of isolated hematochezia and FC cut-offs for discriminating colorectal polyps were explored.
Results
A total 127 patients were included. Thirty-five patients (27.6%) had colorectal polyps, followed by anal fissure (14.2%), ulcerative colitis (UC; 12.6%), and others. A significant difference in FC levels was observed between patients with colorectal polyps (median, 278.7 mg/kg), anal fissures (median, 42.2 mg/kg), and UC (median, 981 mg/ kg) (P < 0.001). According to receiver operating characteristic curve analysis, among patients diagnosed with colorectal polyp or anal fissure, the most accurate FC cut-off for discriminating colorectal polyps from anal fissures on colonoscopy was 225 mg/kg (sensitivity, 59.4%; specificity, 94.4%; positive predictive value [PPV], 95.0%; negative predictive value [NPV], 56.7%; area under the curve [AUC], 0.8; 95% confidence interval [CI], 0.678–0.923; P < 0.001), while among patients diagnosed with colorectal polyp or UC, the most accurate FC cut-off for discriminating colorectal polyps from UC on colonoscopy was 879 mg/kg (sensitivity, 81.2%; specificity, 56.2%; PPV, 78.8%; NPV, 60.0%; AUC, 0.687; 95% CI, 0.521–0.852; P < 0.001).
Conclusion
FC may assist in assessing the cause of lower gastrointestinal tract bleeding in children who present with isolated hematochezia.

Keyword

Fecal Calprotectin; Colorectal Polyp; Anal Fissure; Ulcerative Colitis; Hematochezia
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