Capsule endoscopy (CE) in pediatric gastroenterology has become a routine procedure. The experience of our group is noted in a recent study (JPGN 2012; 54: 409-13). In this study, our single pediatric center reviewed 284 CE procedures (277 patients) over a five-year period. The youngest patient to swallow a capsule was 4.6 years old. Twenty capsules were placed endoscopically, with the youngest & smallest patient being 3 years old (13.5kg). A patency capsule was used in 23 patients.
Overall, the yield with CE was high. 205 (72%) had positive findings; 154 (54%) had small bowel findings. The study also compared its data to pediatric and adult meta-analysis. Similar to other pediatric studies, Crohn disease was the most common indication; in adult studies, CE is used mostly for occult GI bleeding and anemia. CE procedures did not reach the colon in 65 (21%); 36 of these incomplete procedures had positive findings.
Capsule retention occurred in seven patients (2.4%) which is similar to the meta-analysis studies as well. Six of the seven had surgery due to capsule retention, though one surgical procedure had been planned and capsule helped identify stricture site. In addition, one of the seven was retrieved through a tight ileostomy.
- -Gastroenteology 2010; 139: 1468. Predictions for upcoming advances.
- -Gastroenterology 2009; 137: 1197. Strongest indication -obscure bleeding.
- -JPGN 2009; 49: 196. Capsule retention in 5.2% in known IBD. overall 3 of 207 studies (1.4%) To date, >170,000 capsule studies worldwide.
- -Gastrointest Endosc 2008; 68: 255-66. Authors recommend using CT/colonoscopy as primary investigations & reserving capsule only if negative initial evaluation. 17% of pts had asymptomatic partial small bowel obstruction -contraindicating use of capsule.
- -Endoscopy 2008; 40: 30-35 & -IBD 2008; 14: 1287. Consider wireless capsule before IPAA in UC.
- -IBD 2008; 14: 1219. Correlation of capsule & MRI enterolysis. Capsule detected more mucosal lesions.
- -JPGN 2008; 47: 31. Capsule endoscopy may reclassify pediatric IBD
- –Speed matters. Additional references listed on this previous blog entry.