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Capsule Endoscopy Useful, Safe in Children

Gastrointest Endosc. Published online May 17, 2010. Abstract

Wireless capsule endoscopy is safe and useful in children as small as 25 pounds (11.5 kg), according to a single-center retrospective study reported online May 17th in Gastrointestinal Endoscopy.

The diagnostic yield of capsule endoscopy in the researchers' pediatric population was similar to that in adult series and was higher for the evaluation of suspected or known inflammatory bowel disease (IBD).

Furthermore, "capsule retention requiring retrieval did not pose life-threatening risk," the authors said.

Led by Dr. Richard J. Noel of the Medical College of Wisconsin in Milwaukee, the investigators reviewed 123 consecutive capsule endoscopy studies done in 117 patients. The children had a median age of 12.9 years; the youngest patient was 10 months old. Their median weight was 103.4 lb (47 kg), with a range of 25.3 lb (11.5 kg) to 272.1 lb (123.7 kg).

The most common indication for endoscopy was suspected IBD (n = 71; 60.7%), followed by known IBD (n = 18; 15.4%), known polyposis syndrome (n = 6; 4.9%), persistent vomiting/possible stricture (n = 3, 2.5%) and posttransplant lymphoproliferative disease (n = 2; 1.7%).

Most children (70%) swallowed the Given capsule (Given Imaging), the youngest being 5.8 years old. When children couldn't swallow it, an endoscopist placed the capsule in the proximal duodenum.

Twenty-seven (22%) studies were incomplete (i.e., the capsule was not in the colon within 8 hours). In 3 patients, the capsule never left the stomach, and another 4 "simply had slow gastric and/or small bowel transit." Most capsules passed spontaneously, but one didn't pass until day 22, after lavage with Go-Lytely. Two capsules had to be retrieved endoscopically and 3 required surgery (in 2 patients with stenosis from Crohn's disease and in 1 with a tumor obstructing the small bowel). "All retrievals were performed electively without signs of acute bowel obstruction, perforation, or ischemic compromise," the authors said.

On multivariate analysis, endoscopic placement and female sex were associated with about a threefold greater likelihood of incomplete studies. Multivariate analysis also showed that mixed imaging (differing results on multiple studies) versus normal imaging raised the odds of incomplete studies more than 11-fold (OR, 11.5).

Overall, capsule endoscopy produced a new diagnosis in 21 (18%) of the 117 patients. Of the 71 patients who underwent capsule endoscopy for suspected Crohn's disease based on clinical symptoms, 12 (17%) received new diagnoses, including Crohn's disease in 9, vascular abnormalities in 1, celiac disease in 1 and ulcerative colitis in 1. In the remaining 59 children (83%), the researchers were able to exclude Crohn's disease.

In the 18 patients with known IBD, capsule endoscopy revealed "unremarkable small bowel" in 6; uncontrolled small-bowel disease with Crohn's disease in 6; enteropathy not considered classic for Crohn's disease in 2; postoperative caliber change or stricture not seen on prior imaging in 2; small-bowel disease with previous indeterminate colitis in 1; and normal small bowel in previous indeterminate colitis in 1.

In 18 patients with occult GI bleeding, capsule endoscopy revealed arteriovenous malformation in 5; nonspecific enteropathy in 5; normal small bowel in 5; findings consistent with graft-versus-host disease in 1; and lymphangiectasia in 1. (One patient had an incomplete study.)

In the 6 patients with polyposis syndromes, the procedure showed no small-bowel polyps in 3 (50%) and in 1 each, gastric polyps only, gastric and duodenal polyps, and "shaggy" villi with a single large jejunal polyp.

Based on their experience, Dr. Noel and colleagues conclude that capsule endoscopy "may be used to identify stenotic disease beyond traditional endoscopic and radiographic reach...across the spectrum of the pediatric population, from infancy to adulthood and with a weight as low as 11.5 kg (25.3 lb)."