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Quality of colonoscopy in children with rectal bleeding in Egypt



Colonoscopy is the diagnostic evaluation of choice in cases of rectal bleeding (RB). Colonoscopy in children is different from that in adults, but the technique of the examination is similar. Colonoscopy is a technically demanding procedure with the potential for harm if performance is unsatisfactory, and thus assurance of quality is pivotal. A colonoscopy quality-assurance program was instituted in 2003.


The aim of this study was to determine the quality of colonoscopy in children with RB after introducing a colonoscopy quality-assurance program.

Patients and methods

The study was cross-sectional and hospital-based. It was undertaken between 2010 and 2013 on 107 children who underwent colonoscopy for the evaluation of RB.


A total of 112 colonoscopies were assessed. A diagnosis was established in 69 (62%) colonoscopies and polyps were detected in 52%. Cecal intubation was achieved in 107 (90%). The main reason for an unsuccessful cecal intubation was poor bowel preparation. The adjusted completion rate was 97%. The mean time to reach the cecum was 16 min. The mean time for completion of the procedure was 31 min. Colon preparation was rated adequate in 63 (56%) colonoscopies. A total of 119 polyps were detected in 58 colonoscopies, with an average of two polyps per colonoscopy (range 1–7). In all, 113 polyps were excised. All polyps were judged to be completely removed in 52 (95%) colonoscopies. Polypectomy was not performed in three colonic examinations with solitary polyps. Five (4%) patients had postprocedural vomiting. There was one (1%) sedation-related complication (respiratory distress), but no procedure-related complications or mortality.


A high standard of colonoscopy in children with RB can be achieved by introducing a colonoscopy quality-assurance program.


  1. Wolfram W, Reynolds M, Abramson L, Arensman R, Bensard D, Halpern J, et al. Pediatric gastrointestinal bleeding workup; 2013. Available at: [Last accessed on 2013].

  2. Park JH. Role of colonoscopy in the diagnosis and treatment of pediatric lower gastrointestinal disorders. Korean J Pediatr 2010; 53:824–829.

    Article  Google Scholar 

  3. Ament M, Gershman G. Pediatric colonoscopy; 2004. Available at: [Last accessed on 2013].

  4. The ASGE Standards of Practice Committee. Modifications in endoscopic practice for pediatric patients. Gastrointest Endosc 2008; 67:1–9.

    Article  Google Scholar 

  5. Friedt M, Welsch S. An update on pediatric endoscopy. Eur J Med Res 2013; 18:1–7.

    Article  Google Scholar 

  6. Israel M, McLain B, Hassall E. Successful pancolonoscopy and ileoscopy in children. J Pediatr Gastroenterol Nutr 1994; 19:283–289.

    Article  CAS  Google Scholar 

  7. Balfour TW. Training for colonoscopy. J R Soc Med 1999; 94:160–161.

    Article  Google Scholar 

  8. Faigel D. OMED guidelines for credentialing and quality assurance in endoscopy. Gastroenterol Hepatol 2010; 6:216–217.

    Google Scholar 

  9. O’Mahony S, Naylor G, Axon A. Quality assurance in gastrointestinal endoscopy. Endoscopy 2000; 32:483–488.

    Article  Google Scholar 

  10. Gado A, Ebeid B, Axon A. High quality colonoscopy in a low volume unit; is it achievable?. Arab J Gastroenterol 2010; 11:161–164.

    Article  Google Scholar 

  11. Gado A, Ebeid B, Metwali A, Axon A. Improving the detection rate of microscopic colitis by introducing a colonoscopy quality assurance program. Arab J Gastroenterol 2010; 11:223–226.

    Article  Google Scholar 

  12. Gado A, Ebeid B, Abdelmohsen A, Axon A. Improving the yield of histological sampling in patients with suspected colorectal cancer during colonoscopy by introducing a colonoscopy quality assurance program. Gastroenterol Res 2011; 4:157–161.

    Google Scholar 

  13. Gado A, Ebeid B, Abdelmohsen A Axon A. Improving the quality of endoscopic polypectomy by introducing a Colonoscopy Quality Assurance Programme. Alex J Med 2013; 49:317–322.

    Article  Google Scholar 

  14. Bjorkman DJ, Popp JW. Measuring the quality of endoscopy. Gastrointest Endosc 2006; 63:S1–S2.

    Article  Google Scholar 

  15. Morán Sánchez S, Torrella E, Esteban Delgado P, Baños Madrid R, García A, Ono A, et al. Colonoscopy quality assessment. Rev Esp Enferm Dig 2009; 101:107–112.

    Article  Google Scholar 

  16. Dekker E. Quality issues: how can we optimize colonoscopy performance?; 2013. Available at: [Last accessed on 2013].

  17. El-Mouzan MI, Abdullah AM. Yield of colonoscopy in children with rectal bleeding. Saudi Med J 2004; 25:998–1001.

    PubMed  Google Scholar 

  18. Clarke G, Robb A, Sugarman I, McCallion WA. Investigating painless rectal bleeding – is there scope for improvement?. J Pediatr Surg 2005; 40:1920–1922.

    Article  Google Scholar 

  19. Catana D, Van Loon S, Catana I. Colonoscopic polipectomy in children. J Pediatr Gastroenterol Nutrit 2004; 39:S348.

    Google Scholar 

  20. Perisic VN. Colorectal polyps: an important cause of rectal bleeding. Arch Dis Childhood 1987; 62:188–203.

    Article  CAS  Google Scholar 

  21. Mamula P, Markowitz JE, Neiswender K, Baldassano RN, Liacouras CA. Success rate and duration of paediatric outpatient colonoscopy. Dig Liver Dis 2005; 37:877–881.

    Article  CAS  Google Scholar 

  22. Williams C, Laage N, Campbell C, Douglas J, Walker-Smith J, Booeth I, et al. Total colonoscopy in children. Arch Dis Childhood 1982; 57:49–53.

    CAS  Google Scholar 

  23. Thapa BR, Mehta S. Diagnostic and therapeutic colonoscopy in children: experience from a pediatric gastroenterology centre in India. Indian Pediatr 1991; 28:383–389.

    CAS  PubMed  Google Scholar 

  24. Van Rijn JC, Reitsma JB, Stoker J, Bossuyt PM, van Deventer SJ, Dekker E. Polyp miss rate determined by tandem colonoscopy: a systematic review. Am J Gastroenterol 2006; 101:343–350.

    Article  Google Scholar 

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Correspondence to Ahmed S. Gado MD.

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Gado, A.S., Ebeid, B.A., Abdelmohsen, A.M. et al. Quality of colonoscopy in children with rectal bleeding in Egypt. Egypt J Intern Med 27, 21–25 (2015).

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  • children
  • colonoscopy
  • quality
  • rectal bleeding