Schistosomal (bilharzial) polyps: Travel through the colon and beyond.

Schistosomiasis (bilharziasis) is a major neglected tropical disease. It is endemic in many tropical and subtropical communities. Schistosomal polyps (S. polyps) are not uncommon presentation of this infection. Although the colon is the most commonly affected organ, many other organs are affected. S. polyps are associated with a variable range of morbidity independent of the Schistosomal infection. S. polyps are frequently described in endemic areas and increasingly reported in non-endemic areas mainly among immigrants and visitors to the endemic areas. This review aimed to increase awareness of practitioners, especially gastroenterologists, for this peculiar type of polyps caused by this neglected infection hence improving patient outcomes. Web-based search of different databases was conducted for the literature focusing the development of S. polyps in the colon and other organs with analysis of the clinical manifestations, diagnosis and treatment. The following key words were used in the search, "Schistosomiasis" OR "Bilharziasis" AND "Polyps" OR "Polyp" AND "Colon" OR "Small intestine" OR " Duodenum" OR " Stomach" OR "Esophagus" OR " Gallbladder" OR" Pharynx" OR "Larynx" OR "Trachea" OR "Urinary bladder" OR " Ureter" OR "Renal Pelvis" OR "Urethra". All publication types including case reports, case series, original research, and review articles were retrieved and analyzed. S. polyps are not infrequent presentation of acute or chronic Schistosomal infection. S. polyps are described in many organs including the bowel, genitourinary tract, skin, gallbladder and the larynx. Presentation of S. polyps is variable and depends on the site, number as well as the polyp size. The relationship of S. polyps to malignant transformation is a matter of discussion. Presence of S. polyps is sometimes the only manifestation of Schistosomiasis. Small polyps can be treated medically with praziquantel, while large accessible polyps are amendable for endoscopic excision through different polyp resection techniques. However, huge, complicated, non-accessible and suspicious polyps are indicated for surgical management or advanced endoscopic resection when appropriate. Clinicians and endoscopists should be aware about these facts when treating patients living in, immigrated from or visiting endemic areas.

Safety and outcomes of percutaneous endoscopic gastrostomy tubes in children.

BACKGROUND/AIM: Gastrostomy tube feeding is indicated for children who require prolonged enteral tube feeding. Different techniques for gastrostomy tube insertion exist, and include percutaneous endoscopic gastrostomy (PEG) tube insertion. Our primary goal was to review the indications, associated complications, and outcomes from PEG tube insertion in children treated in our institution. Our secondary goal was to assess possible risk factors for the associated complications. METHODS: This was a retrospective chart review study. It involved children who had received PEG tubes between 2017 and 2019. Data collected included demographics, indications for PEG placement, associated comorbidities, minor and major complications encountered, and patients' outcomes after PEG placement. . Statistical analysis was performed to determine possible risk factors for predicting the encountered complications. RESULTS: A total of 25 PEG tubes were placed during the study period. There were 14 females (56%), and the average age of the patients was 43.8 months (range: 1-188 months). The most common indication for PEG placement was failure to thrive (40%), followed by feeding problems (32%) and recurrent aspiration (28%). Neurological conditions (84%) were the most common associated comorbidity, followed by hematological (44%) and genetic (24%) conditions. A very small percentage (4%) experienced one major complication, and about 32% of the patients experienced at least one minor complication. The most common minor complication was PEG tube site infection. No risk factors could predict the encountered complications. CONCLUSIONS: PEG tube placement continues to be a safe technique in children. The most common indication of PEG placement is failure to thrive. PEG tube site infection continues to be the most common minor complication associated with PEG placement. No specific risk factors were found to predict the encountered complications.