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Pediatric Capsule Endoscopy: Review of the Small Bowel and Patency Capsules

Cohen, Stanley A.*; Ephrath, Hagit; Lewis, Jeffery D.*; Klevens, Alan; Bergwerk, Ari; Liu, Steven*; Patel, Dinesh*; Reed-Knight, Bonney*; Stallworth, Angela*; Wakhisi, Tamara*; Gold, Benjamin D.*

Journal of Pediatric Gastroenterology & Nutrition: March 2012 - Volume 54 - Issue 3 - p 409–413
doi: 10.1097/MPG.0b013e31822c81fd
Original Articles: Gastroenterology

Background and Objective: Because capsule endoscopy (CE) avoids ionizing radiation, deep sedation, and general anesthesia, CE may be valuable in pediatrics. We report a single pediatric center's experience with the use and safety of CE.

Methods: In a retrospective review of consecutive CE studies, 284 CE studies were performed in 277 patients with a mean age of 15 (±3.7) years during a 5-year period. The youngest to swallow the capsule was 4.6 years old. Twenty capsules were placed. Overall, 245 (86%) patients underwent CE for suspected (184, 65%) or confirmed (61, 21%) Crohn disease (CD); 27 (9.5%) anemia or gastrointestinal bleeding; 6 (2%) polyposis; and 4 (1.4%) celiac disease.

Results: Positive findings were observed in 205 (72%) of the studies, with 152 (54%) having small bowel findings. Of these, 72 (47%) were diagnostic. Gastric (95, 33%) and colonic (31, 11%) abnormalities were also identified. Five CE studies (1.8%) resulted in retention of the capsule in nonsurgical patients. A patency capsule before CE in 23 patients allowed 19 CE to proceed with only 1 retained capsule. In 65 (21%) patients, the video capsule did not enter the colon before the video's end. Of these, 36 (65%) had significant findings, including 27 (49%) documenting small bowel (SB) CD.

Conclusions: CE is useful to diagnose SB disease in children. Even in a study population with a high prevalence of confirmed and suspected CD, the risk of retention remains small. The patency capsule may lessen that risk. CE may identify gastric or colonic disease even when SB lesions are not present.

*Children's Center for Digestive Health Care, Children's Healthcare of Atlanta, Atlanta, GA

Given Imaging, Yokneam, Israel.

Address correspondence and reprint requests to Stanley A. Cohen, MD, Children's Center for Digestive Health Care, 993-D Johnson Ferry Rd, Suite 440, Atlanta, GA 30342 (e-mail: scohen@ccdhc.org).

Received 14 May, 2011

Accepted 5 July, 2011

This research was supported in part by Given Imaging, Yokneam, Israel.

S.A.C. is a consultant for Given Imaging, Centocor, and UCB, and serves on the speakers’ bureaus for those entities and for Prometheus Laboratories. A.B., H.E., and A.K. are employees of Given Imaging. The other authors report no conflicts of interest.

Copyright 2012 by ESPGHAN and NASPGHAN