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[Peroral duodeno-jejunal biopsy in children. Indications and personal cases]
Insights
Pediatric intestinal biopsies using the Crosby capsule are safe and highly sensitive for diagnosing conditions like celiac disease. This diagnostic method proved superior to other intestinal absorption tests in children.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Endoscopy
- Histopathology
Context:
- Evaluation of diagnostic procedures in pediatric gastrointestinal disorders.
- Experience with 50 intestinal biopsies in 35 children over 14 months.
- Established technique utilizing the Crosby capsule at the duodenojejunal flexure.
Purpose:
- To report the experience and describe the technique for pediatric intestinal biopsies.
- To assess the diagnostic yield and safety of the Crosby capsule biopsy method.
- To compare the sensitivity of this technique with other intestinal absorption tests.
Summary:
- Fifty intestinal biopsies were performed on 35 children using the Crosby capsule under fluoroscopic guidance with a multimodal sedation protocol.
- Histopathological examination revealed various degrees of villous atrophy, including sub-total and partial atrophy, with 29 cases showing normal morphology.
- The technique successfully diagnosed celiac disease (8 cases), suspected celiac disease (3 cases), dermatitis herpetiformis (3 cases), and other intolerances (2 cases).
Impact:
- Confirms the significant diagnostic value and safety of intestinal biopsy in pediatric patients.
- Demonstrates high sensitivity, exceeding other available tests for intestinal absorption.
- Provides a reliable method for diagnosing pediatric gastrointestinal conditions, including celiac disease and food protein intolerances.
Abstract:
In this study we report our experience with 50 intestinal biopsies carried out in 35 children in a 14 months period (October 1979-December 1980) and we also describe the technique we use. The biopsy has been performed by two operators using the Crosby capsule, placed at the duodenojejunal flexure under fluoroscopic screening. For sedation we used oral Promazine and viscous xylocaine and i.v. Metoclopramide and Diazepam; the sedation has been classified in 4 degrees and resulted very good in 40 cases, good in 8 cases and sufficient in 2. The biopsy specimens has been examined with dissecting and light microscope and demonstrated 14 sub-total villous atrophy, 2 severe partial villous atrophy, 5 partial villous atrophy and 29 normal villous morphology. By this technique we made a diagnosis of Coeliac disease in 8 cases, suspected Coeliac disease in 3 cases, Dermatitis Herpetiformis in 3 cases and cow's milk proteins intolerance and post-enteritis syndrome in 1 case. No complications occurred during or after intubation. The AA. confirm the diagnostic value of this investigation, its safety and its very high degree of sensitivity superior to any other test of intestinal absorption.