Wireless capsule endoscopy for obscure small-bowel disorders: final results of the first pediatric controlled trial.
OBJECTIVE
Obscure small-bowel disorders are jejunal and ileal lesions undiagnosed by traditional imaging techniques (endoscopic, radiologic). We evaluated the diagnostic usefulness and safety of capsule endoscopy for obscure small-bowel disorders in children and adolescents.


METHODS
Comparative, prospective, self-controlled trials in patients (age, 10-18 y) suspected to have either small-bowel Crohn's disease, polyps, or obscure gastrointestinal (GI) bleeding. Capsule results were compared with the diagnostic imaging studies normally used in this age group.


RESULTS
Among 20 patients suspected of Crohn's disease, multiple lesions consistent with this diagnosis were observed by capsule endoscopy in 50%. Small-bowel Crohn's disease was ruled out in 8 patients. Eosinophilic enteropathy was found in 2 others. For polyp detection (n = 6), capsule endoscopy yielded 100% concordance with the control studies when analyzed per patient. However, capsule endoscopy revealed a greater number (50%) of polyps. Among patients with obscure bleeding (n = 4), the capsule examination confirmed a diagnosis of vascular malformations in 3. Capsule endoscopy more accurately identified the precise source of bleeding compared with angiography. All 30 capsule studies were well tolerated, although 1 capsule was retained owing to an inflammatory stenosis. The capsule eventually was expelled after corticosteroid therapy.


CONCLUSIONS
Capsule endoscopy correctly diagnosed or excluded a bleeding source, small-bowel polyps, or Crohn's disease of the small bowel in 29 of 30 patients. Capsule endoscopy permits an accurate, noninvasive approach for diagnosing obscure small bowel lesions in children over the age of 10.
Guilhon de Araujo Sant'Anna
Ana Maria
AM
Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Sainte-Justine Hospital, University of Montréal, Montréal, Québec, Canada.
Dubois
Josée
J
Miron
Marie-Claude
MC
Seidman
Ernest G
EG
D000293:Adolescent; D002214:Capsules; D002648:Child; D003424:Crohn Disease / Q000175:diagnosis*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis; D006801:Humans; D007077:Ileal Diseases / Q000175:diagnosis*; D007417:Intestinal Polyps / Q000175:diagnosis; D007579:Jejunal Diseases / Q000175:diagnosis*; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome
D002214:Capsules