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Clinical application and diagnostic yield of wireless capsule endoscopy in children
Brice Antao1, Jonathan Bishop, Rang Shawis
1Pediatric Surgical Unit and Sheffield Children's Hospital, Sheffield, United Kingdom. briceantao@doctors.org.uk
Insights
Wireless capsule endoscopy (WCE) is an effective tool for diagnosing pediatric small bowel diseases. This noninvasive method offers superior sensitivity and impacts management decisions in children with suspected gastrointestinal conditions.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Endoscopy
Background:
- Small bowel examination is challenging with traditional methods.
- Invasive and indirect modalities have limitations.
- Wireless capsule endoscopy (WCE) offers a novel approach.
Purpose of the Study:
- To evaluate the efficacy of WCE in pediatric patients.
- To assess the clinical impact of WCE in diagnosing small bowel diseases.
- To compare WCE with conventional diagnostic tools.
Main Methods:
- 37 children with suspected small bowel disease underwent WCE.
- Indications included Crohn's disease, bleeding, and polyposis syndromes.
- WCE findings were compared to prior upper endoscopy, colonoscopy, and small bowel follow-through (SBFT).
Main Results:
- WCE achieved an 85% diagnostic yield in 33 patients.
- Key findings included Crohn's disease (13), gastrointestinal bleeding sources (7), and polyposis syndromes (3).
- WCE demonstrated higher sensitivity than SBFT and other endoscopic investigations, leading to altered management in 85% of cases.
Conclusions:
- WCE is a safe, noninvasive, and highly sensitive tool for pediatric small bowel evaluation.
- It surpasses conventional methods in diagnosing small bowel pathology.
- WCE should be integrated into the routine diagnostic work-up for children with suspected small bowel conditions.
Objective:
The small bowel is anatomically difficult to examine and was investigated by invasive, indirect modalities, such as push enteroscopy and small bowel follow-through. The aim of this study was to assess the efficacy and clinical impact of wireless capsule endoscopy (WCE) in children.
Materials And Methods:
Over the last 3 years (2002-2005), 37 patients with suspected small-bowel disease were investigated with WCE at a median age of 11 years (range, 16 months-16 years). The indications for WCE was suspected Crohn's disease (CD) (18), obscure or occult gastrointestinal bleeding (7), polyposis syndromes (5), protein losing enteropathy (4), recurrent abdominal pain (2), and malabsorption syndrome (1). All patients had preceding upper gastrointestinal endoscopy (OGD), ileocolonoscopy, and 26 cases had a small bowel follow-through (SBFT). These results were compared with the findings on WCE.
Results:
Thirty-three (33) cases successfully completed the WCE through the small bowel. Four (4) patients were unable to swallow the capsule, 3 of which had to be placed in the duodenum endoscopically. In 3 patients, the capsule remained in the stomach and no small bowel images were obtained. The overall diagnostic yield was 85% (28/33 patients). The diagnostic findings included CD (13), source of gastrointestinal bleeding (7), polyposis syndromes (3), erosive enteropathy and patchy lymphangiectasia (4), and intussusception (1). WCE was found to be more sensitive for small bowel pathology than SBFT (20 vs. 6 [30% sensitivity, compared to WCE]) and endoscopic investigations (28 vs. 12 [43% sensitivity compared to WCE]). As a result of WCE findings, there was a positive alteration in the management in 28 of 33 (85%) cases.
Conclusions:
WCE is a novel, noninvasive, and useful tool for the investigation of the small intestine in children. It is superior and more sensitive than other conventional endoscopic and radiologic investigations in the assessment of the small bowel. It can help in guiding surgical decisions and should be routinely integrated as a part of the diagnostic work-up of small bowel pathology.
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