Beyond diagnosis: the emerging role of fecal calprotectin in longitudinal management of pediatric juvenile polyps

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.