Persistent and recurrent hematochezia in neonates and infants: The role of endoscopy

OBJECTIVES: Hematochezia is a frequent cause of hospitalization during early infancy. Gastrointestinal endoscopy (GE) is widely used in older children, but its role in neonates and infants remains debated because of concerns regarding safety and limited diagnostic yield. The aim of this study is to evaluate the safety, diagnostic, and therapeutic impact of GE in infants aged 0-6 months presenting with persistent or recurrent hematochezia. METHODS: We retrospectively reviewed medical records of infants younger than 6 months admitted for hematochezia at the "Bambino Gesù" Children Hospital between January 2017 and May 2023. GE was performed in cases of persistent or recurrent bleeding or bleeding associated with anemia. Demographic, clinical, endoscopic, histological, therapeutic, and outcome data were collected and analyzed. RESULTS: Seventy-three infants were included. In 47 cases (64.4%), hematochezia was clinically diagnosed and resolved without endoscopic evaluation. Eight infants (10.9%) underwent colonoscopy because of persistent or recurrent bleeding. All procedures were completed successfully without peri- or post-procedural complications. Endoscopy achieved a definitive diagnosis in all cases, identifying eosinophilic proctocolitis (n = 6), very early-onset inflammatory bowel disease (n = 1), and colonic fibrosarcoma (n = 1). Endoscopic findings directly guided management in all patients, leading to resolution of bleeding. CONCLUSIONS: While most infants with hematochezia can be managed conservatively, lower GE appears to be safe in carefully selected patients with recurrent or persistent symptoms when performed by experienced pediatric teams. Endoscopy enables definitive diagnosis and targeted, sometimes life-saving, treatment. These studies support a selective use of endoscopy in this population, while acknowledging the limitations related to the retrospective design and small sample size.