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Capsule endoscopy performed across the pediatric age range: indications, incomplete studies, and utility in
M Kyle Jensen1, Neelesh A Tipnis, Ruta Bajorunaite
1Division of Pediatric Gastroenterology, Medical College of Wisconsin/Children's Hospital of Wisconsin, Milwaukee, Wisconsin 53226, USA.
Insights
Capsule endoscopy (CE) in children can be incomplete, especially with prior abnormal imaging or endoscopic placement. However, CE provides an 18% diagnostic yield and is safe for identifying small bowel stenosis.
Area of Science:
- Pediatric Gastroenterology
- Medical Imaging
- Diagnostic Endoscopy
Background:
- Capsule endoscopy (CE) is increasingly used for pediatric small bowel evaluation.
- Pre-CE upper GI series are recommended to assess obstruction risk.
- Pediatric CE safety and diagnostic yield data are limited compared to adult studies.
Purpose of the Study:
- To determine factors linked to incomplete pediatric capsule endoscopy studies.
- To assess the diagnostic yield of capsule endoscopy in children.
Main Methods:
- Retrospective review of 123 consecutive pediatric CE studies (2005-2008).
- Data collected included demographics, indications, placement technique, and imaging results.
- Bivariate and multivariate regression analyzed risk factors for incomplete studies.
Main Results:
- 27% of pediatric CE studies were incomplete.
- Factors associated with incomplete studies included abnormal prior imaging, endoscopic placement, and female sex.
- Capsule endoscopy yielded new diagnoses in 18% of pediatric patients, with a higher yield (28%) in those with known inflammatory bowel disease.
Conclusions:
- Capsule endoscopy is a safe and valuable tool for pediatric small bowel evaluation, even in children as young as 11.5 kg.
- CE can identify small bowel stenosis, and capsule retention did not pose life-threatening risks.
- Further research is needed to address incomplete follow-up in retrospective pediatric studies.
Background:
Capsule endoscopy (CE) is used increasingly to evaluate the small bowel in children. An upper GI series is recommended before CE to evaluate the risk of obstruction. Despite normal findings on an upper GI series, CE may still be incomplete. Although large adult studies have demonstrated the safety and diagnostic yield of CE, similar pediatric studies have not been available.
Objective:
To identify factors associated with incomplete studies and the diagnostic yield in pediatric patients.
Design:
Retrospective review of consecutive CE studies from February 2005 through June 2008.
Setting:
Large tertiary children's hospital.
Patients:
A total of 123 CE studies in 117 patients; median age 12.9 years (range 0.8-22.4 years).
Main Outcome Measurements:
Demographic information, indication, placement technique, pre-CE imaging results, and cecal completion status were recorded. Risk factors were analyzed with bivariate and multivariate regression analysis.
Results:
There were 27 (22%) incomplete studies; of these, there were normal pre-CE radiologic study findings in 12 (44%), and findings requiring medical, endoscopic, or operative intervention in 6. Of the 117 patients, CE produced a new diagnosis in 21 (18%). Abnormal findings on previous imaging (odds ratio [OR] 3.0; 95% CI, 1.2-8.0), endoscopic placement (OR 3.1; 95% CI, 1.1-8.4), and female sex (OR 3.3; 95% CI, 1.2-9.4) were associated with incomplete studies.
Limitations:
Retrospective, incomplete follow-up.
Conclusions:
CE may be performed in children as small as 11.5 kg, with 18% yield in all studies, and 28% in pediatric known inflammatory bowel disease. Capsule retention requiring retrieval did not pose life-threatening risk in our series, and CE may be used to identify disease-associated small-bowel stenosis.
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