Pediatric Colonoscopy in Baghdad, Iraq: A Prospective Analysis of Clinical Indications, Endoscopic Findings, and Histopathological Outcomes at a Tertiary Pediatric Hospital

Abstract

Background: Pediatric colonoscopy differs from adult practice in multiple aspects, including patient management, sedation and anesthesia selection, bowel preparation, expected diagnoses, instrument choice, and the need for biopsies from macroscopically normal mucosa. Local data from Iraq are scarce. Objectives: To describe the demographic and clinical characteristics of children undergoing colonoscopy, to report endoscopic and histopathological findings, and to observe the relationship between procedure indications, endoscopic appearance, and final diagnosis. Methods: A prospective cross-sectional observational study was conducted at the Gastroenterology Unit of the Children Welfare Teaching Hospital, Baghdad, from 1 May to 1 December 2023. All children younger than 15 years who underwent colonoscopy during the study period were included. Demographic data, clinical indications, endoscopic findings, and histopathological diagnoses were recorded. Procedures were performed in scheduled pediatric sessions with trained endoscopy staff. Results: A total of 105 children [mean age 8.25 ± 3.6 years; 44 males (41.9%), 61 females (58.1%)] were studied. The most common indications were bleeding per rectum (38.1%), diarrhea (25.7%), and abdominal pain (17.1%). Endoscopy was normal in 29.5% of cases. Abnormal findings included non-specific colitis in 21.9%, inflammatory bowel disease (IBD) in 21.0%, and polyps in 14.3%. All polyps were rectal and histologically juvenile. Conclusions: In this first Iraqi pediatric colonoscopy cohort, pediatric colonoscopy for lower GI symptoms was most commonly indicated for rectal bleeding and chronic diarrhea, with colonic inflammation (IBD, nonspecific colitis) and polyps as frequent diagnoses. Complete colonoscopy with ileal intubation is crucial for IBD assessment, though these single-center findings require cautious interpretation.