Fecal calprotectin (FCP) is an established noninvasive marker of intestinal inflammation, but its clinical relevance in children with juvenile polyps extends beyond the initial diagnostic evaluation. Available studies consistently show that FCP is elevated in most affected children and decreases markedly after complete polypectomy. Some data also suggest an association with polyp size, although this finding has not been reproduced in all cohorts. These observations suggest that FCP reflects lesion-associated inflammatory activity and the response to its removal. More limited longitudinal evidence suggests that re-elevation after initial normalization may accompany polyp recurrence. This mini-review examines the biological basis and clinical evidence for FCP in pediatric juvenile polyps across the disease course, from detection and assessment of lesion burden to post-polypectomy follow-up. Important uncertainties remain regarding the contribution of gastrointestinal bleeding, the mechanisms underlying markedly elevated values, and the accuracy and optimal timing of serial measurements. FCP should therefore be viewed as a promising adjunct rather than a substitute for clinical assessment and colonoscopy. Prospective studies are required to determine whether FCP trajectories can safely support longitudinal management and targeted post-polypectomy surveillance.

Background and Study Aims Delayed bleeding after cold snare polypectomy of 4-9 mm nonpedunculated colorectal polyps is rare, but persistent immediate bleeding is relatively common and lacks a standardized management framework. We prospectively evaluated 30-day outcomes of a standardized selective clipping protocol for persistent immediate bleeding after cold snare polypectomy. Patients and Methods In this prospective, single-center cohort study, consecutive adults with at least one eligible 4-9 mm nonpedunculated colorectal polyp resected by cold snare polypectomy between January 1 and December 31, 2024 were enrolled. All bleeding defects were irrigated and observed for 60s, and clips were applied only for persistent oozing according to a standardized selective clipping protocol. The primary endpoint was delayed bleeding within 30 days after polypectomy. Results Among 2176 patients with 4343 polyps, 315 patients (14.5%) and 369 lesions (8.5%) required clipping for persistent immediate bleeding. Delayed bleeding occurred in 5 patients (0.23%), all confirmed by repeat colonoscopy. Patient-level delayed bleeding rates were 0.63% (2/315) in the selective-clipping group and 0.16% (3/1861) in the group without clipping. Lesion-level delayed bleeding rates were 0.54% (2/369) in clip-treated lesions and 0.13% (5/3974) in unclipped lesions. Exploratory analysis suggested chronic kidney disease and five or more synchronous polyps as candidate risk factors. Conclusions Under a standardized selective clipping protocol, delayed bleeding after cold snare polypectomy of 4-9 mm nonpedunculated colorectal polyps was infrequent in both groups, and all confirmed bleeding events were successfully managed endoscopically.

Peutz-Jeghers syndrome (PJS) is characterized by the association of gastrointestinal (GI) polyposis, mucocutaneous pigmentation, and cancer predisposition. PJS-type hamartomatous polyps are most common in the small intestine (in order of prevalence: jejunum, ileum, and duodenum) but can also occur in the stomach, large bowel, and extraintestinal sites including the renal pelvis, bronchus, gall bladder, nasal passages, urinary bladder, and ureters. GI polyps can result in chronic bleeding, anemia, and recurrent obstruction and intussusception requiring repeated laparotomy and bowel resection. Mucocutaneous hyperpigmentation presents in childhood as dark blue to dark brown macules around the mouth, eyes, and nostrils, in the perianal area, and on the buccal mucosa. Hyperpigmented macules on the fingers are common. The macules may fade in puberty and adulthood. Recognition of the distinctive skin manifestations is important especially in individuals who have PJS as the result of a de novo pathogenic variant as these skin findings often predate GI signs and symptoms. Individuals with PJS are at increased risk for a wide variety of epithelial malignancies (colorectal, gastric, pancreatic, breast, and ovarian cancers). Females are at risk for sex cord tumors with annular tubules (SCTAT), a benign neoplasm of the ovaries, and adenoma malignum of the cervix, a rare aggressive cancer. Males occasionally develop large calcifying Sertoli cell tumors of the testes, which secrete estrogen and can lead to gynecomastia, advanced skeletal age, and ultimately short stature, if untreated.

Double-balloon enteroscopy (DBE) is an essential diagnostic and therapeutic modality for small-bowel disorders. Most prior studies on age-related differences in DBE involved limited age groups and small cohorts. We evaluated age-specific differences in the indications, findings, therapeutic interventions, and complications of DBE in a large single-center cohort. We retrospectively analyzed 817 patients who underwent 1101 DBE procedures between January 2006 and January 2023 at a tertiary center. The patients were grouped as young (18-44 years), middle-aged (45-64 years), and elderly (≥65 years). Demographics, indications, endoscopic and pathological findings, interventions, and complications were compared among groups. Bleeding was the most frequent indication in elderly patients, whereas diarrhea, abdominal pain, inflammatory bowel disease, and polyposis syndromes were more common in younger patients. Inflammatory lesions and polyps predominated in younger patients, whereas vascular lesions and tumors were more frequent in elderly patients (P < .05). Diagnostic interventions predominated in young and middle-aged patients, whereas therapeutic interventions were more common in the elderly (P < .001). Benign and malignant neoplasms were more common in the elderly, whereas celiac disease and polyposis syndrome were more common in younger individuals (P < .05). The overall complication rate was 2.6%, with a higher but nonsignificant rate of anesthesia-related complications in the elderly (P = .11). DBE is safe and effective in all age groups. Age was significantly associated with clinical indications and endoscopic findings, and recognizing these patterns can guide more targeted use of DBE and improve diagnostic accuracy.

Primary familial gastrointestinal stromal tumors (GIST) are characterized by the presence of typically multifocal GIST that most often involve the stomach. Additional gastrointestinal (GI) manifestations can include inflammatory fibroid polyps most often in the stomach or small bowel and interstitial cell of Cajal hyperplasia occurring throughout the GI tract. Skin hyperpigmentation typically involving the neck, face, axillae, groin, and perineum that appears in childhood or adolescence is common. Additional integument findings can include increased nevi, lentigines, and multiple café au lait macules. Less common features include urticaria pigmentosa, cutaneous mastocytosis, and systemic mastocytosis.