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Video Capsule Endoscopy Impacts Decision Making in Pediatric IBD: A Single Tertiary Care Center Experience

Min, Steve B. MD*; Le-Carlson, Minou MD; Singh, Namita MD; Nylund, Cade M. MD§; Gebbia, Jennifer RN, MSN, CPNP; Haas, Kelly MD; Lo, Simon MD; Mann, Neel MD; Melmed, Gil Y. MD; Rabizadeh, Shervin MD; Dubinsky, Marla C. MD

Inflammatory Bowel Diseases:
doi: 10.1097/MIB.0b013e31829a749c
Original Clinical Articles
Abstract

Background: Little is known about the impact of video capsule endoscopy (VCE) on decision making in pediatric patients with IBD. Moreover, few studies have reported on the outcomes of treatment changes made based on VCE findings. Our aim was to identify the added value of VCE in pediatric patients in a tertiary IBD center with established or suspected IBD, by assessing changes in treatments and outcomes before and after VCE.

Methods: A retrospective chart review was performed in children with established (n = 66) or suspected (n = 17) IBD who underwent VCE. Diagnostic classifications, treatments, and clinical outcomes before and 1 year after VCE were compared.

Results: Primary indications for VCE included patients treated for Crohn's disease (CD) with poor growth or active symptoms (60%), patients with ulcerative colitis/IBD-unclassified (19%), and suspected IBD (20%). Abnormal VCE was seen in 86% of patients with CD, of whom 75% underwent treatment escalation. One year after VCE, patients with CD improved in growth (mean z-scores at baseline and 12 months, −0.5 and 0.2, respectively; P < 0.0001), mean body mass index (18.3 and 19.8, respectively; P = 0.004), mean erythrocyte sedimentation rate (25 versus 16, respectively; P = 0.012), and median Harvey–Bradshaw Index (2 and 0, respectively; P = 0.003). VCE revealed more extensive disease than concurrent imaging modalities in 43% of the patients with CD. VCE “ruled out” IBD in 94% who had suspected IBD, whereas 50% with presumed ulcerative colitis/IBD-unclassified had a diagnosis changed to CD.

Conclusions: VCE provides additional clinical information that impacted management of pediatric patients with IBD in a tertiary IBD center and was associated with improved outcomes.

In Brief

Article first published online 17 July 2013

Author Information

*Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD;

Department of Pediatrics, Kaiser Permanente, San Francisco, CA;

Department of Pediatrics, Seattle Children's Hospital, Seattle, WA;

§Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD; and

Departments of Pediatrics and

Medicine, Cedars-Sinai Medical Center, Los Angeles, CA.

Reprints: Steve B. Min, MD, Department of Pediatrics, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889 (e-mail: steven.min@gmail.com).

M. C. Dubinsky: Consultant to Given Imaging. G. Y. Melmed: Consultant to Given Imaging. The remaining authors have no conflicts of interest to disclose.

Disclaimer: The views expressed in this article are those of the authors and do not reflect the official policy or position of the United States Army, the United States Air Force, Department of Defense, or the U.S. Government.

Received April 23, 2013

Accepted May 06, 2013

© Crohn's & Colitis Foundation of America, Inc.

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