We read with interest the recent study on "Spectrum of colonic polyps". Authors have reemphasized the notion that the majority of colonic polyps in children are solitary and rectosigmoid in location. But the method used for preparing a child for colonoscopy is controversial. For oral electrolyte lavage solution containing polyethylerie glycol (PEG), there is no need to keep the child on liquid diet for one day and to give enema a day before. Moreover using PEG a night before will cause great inconvenience to the child and also to. the parents because of frequent motions. It has been recommended(2) that on the day of the procedure (4 hours before colonoscopy) PEG should be used. PEG containing lavage solution is isotonic and isoosmolar to the plasma when reconstituted (1 packet in 2 liters of water)(2) and thereby it prevents water-electrolyte absorption/secretion. However, authors (1) have prepared the PEG solution in 500 to 1000 ml of water, which was obviously hypertonic and hyperosmolar with an increased risk of water- electrolyte imbalance to a small child. Most people even in India(3) now use ketamine, not general anesthesia for sedation during endoscopy in pediatric cases. It is safe and does not require any extensive monitoring system. But in this study(l) general anesthe- sia was used in the majority of cases. In our experience(4) of 236 children with colonic polyp, 93% were juvenile polyp, 76% solitary and 85% were in the rectosigmoid region. Corresponding figures in this sereis(l) are 75%, 80% and 90%. Interestingly, we have seen(5) 17 cases of juvenile polyposis (>5 juvenile polyps) but the present series(l) does not have any such case. Adenomatous changes in a juvenile polyp, which we have documented in 59% cases of juvenile polyposis(5), sometimes completely replace juvenile polyp(6). In such cases, if all polyps are nor-examined carefully a misdiagnosis of adenomatous polyposis, (which, is otherwise rare in India) may be made instead of juvenile polyposis. Authors have mentioned that a single juvenile polyp has no malignant potential and has to be removed only if symptomatic. This is not true. There are reports(7,8) of adenomatous changes and colorectal malignancy in solitary juvenile polyp with adenotnatous changes. Therefore, solitary juvenile polyp carries a small but definite neoplastic potential and needs to be removed even if asymptomatic.

Vinal Poddar,
B.R. Thapa,
Division of Pediatric Gastroenterology, Department of Gastroenterlogy,
Post Graduate Institute of Medical
Education and Research,
Chandigarh 160 012, India.
E-mail: [email protected]