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

• Kim YB
• Kim JY
• Choi S
• Kim HJ
• Lee YM
• Lee Y
• Jang HJ
• Lee EH
• Lee KJ
• Kim SC
• Choi SY
• Kang Y
• Yi DY
• Choi YJ
• Choe BH
• Kang B

• KMID: 2526970
• DOI: http://doi.org/10.3346/jkms.2022.37.e72

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

Figure

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  Fig. 1 Patient inclusion and exclusion.GI = gastrointestinal, FC = fecal calprotectin, UC = ulcerative colitis.

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  Fig. 2 Significant FC level differences between major etiologies of isolated hematochezia.FC = fecal calprotectin.

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  Fig. 3 ROC curve analysis for the discrimination between colorectal polyp and other major etiologies. (A) ROC curve analysis for the discrimination between colorectal polyp and anal fissure. (B) ROC curve analysis for the discrimination between colorectal polyp and ulcerative colitis.FC = fecal calprotectin, AUC = area under the curve; ROC = receiver operating characteristic.

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