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Esophageal Capsule Endoscopy in Children and Young Adults With Portal Hypertension

Pai, Anita K.; Jonas, Maureen M.; Fox, Victor L.

Journal of Pediatric Gastroenterology and Nutrition: December 2019 - Volume 69 - Issue 6 - p 641–647
doi: 10.1097/MPG.0000000000002455
Original Articles: Hepatology
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Objectives: Variceal hemorrhage (VH) is a serious complication of portal hypertension (PH). We evaluated the feasibility, safety, and clinical impact of esophageal capsule endoscopy (ECE) in pediatric and young adult patients with known or suspected PH.

Methods: Children and young adults with PH at Boston Children's Hospital (2005–2017) were offered ECE for variceal screening or surveillance. Patient histories, ECE findings, and clinical outcomes were reviewed retrospectively.

Results: One hundred and forty-nine ECE studies were performed in 98 patients (57.1% male patients) using 3 ECE devices for variceal screening (66.5%) or surveillance (33.5%). Three readers interpreted the studies (88.3%, 10.3%, and 1.4%, respectively). Median age was 16 years (IQR 13.7–18.5). One hundred and three ECE studies involved patients <18 years (69.1%). Fifteen patients (29 ECE studies) had a gastrointestinal (GI) bleeding (GIB) history, 5 in the preceding 12 months.

Sixty-two ECE studies (44.9%) detected varices: 59 esophageal (40 small, 19 medium/large), 17 gastric, 6 duodenal. Other findings included: portal gastropathy (25, 18.1%), esophagitis (20, 14.5%), ulcers (5, 3.6%), erosions (31, 22.5%), heterotopic tissue (13, 9.4%), blood flecks (23, 16.7%), and mucosal scars (17, 12.3%). There were 2 transient capsule retentions and no major adverse events.

ECE led to follow-up EGD in 11 (7 variceal banding) and medication initiation in 12 (4 proton-pump inhibitor, 7 nonselective beta blocker, 2 other) cases. Four patients had GIB within 12 months of ECE.

Conclusion: ECE is a feasible alternative to EGD for screening and surveillance of esophageal varices in children and young adults.

Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA.

Address correspondence and reprint requests to Victor L. Fox, MD, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115 (e-mail: victor.fox@childrens.harvard.edu).

Received 23 November, 2018

Accepted 11 July, 2019

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org).

A.K.P. has no financial disclosures or conflicts of interest to report. M.M.J. has received grant support from Bristol Myers-Squibb, Roche, Gilead, AbbVie, Merck, Echosens, and is a consultant (DSMB) with Gilead. V.F. has received consulting fees as a member of the Clinical Advisory Board on Nutritional Insufficiency for Medtronic.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,