Clinical application and diagnostic yield of wireless capsule endoscopy in children

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.