title: Feasibility of video capsule endoscopy in the management of children with Peutz-Jeghers syndrome: a blinded comparison with barium enterography for the detection of small bowel polyps.
abstract: OBJECTIVE
  Peutz-Jeghers syndrome (PJS) in children may present with anaemia, intussusception, or obstruction from an early age and surgery is common. Prophylactic polypectomy may reduce subsequent complications. Traditional barium enterography (BE) has poor sensitivity and requires significant radiation. We compared the performance of capsule endoscopy (CE) with BE in children with PJS.
  
  
  METHODS
  Children with PJS (ages 6.0-16.5 years) were prospectively recruited and underwent BE followed by CE, each reported by expert reviewers blinded to the alternate modality. Number of "significant" (>10 mm) and total number of polyps were recorded. Child preference was assessed using a visual analogue questionnaire. Definitive findings were assessed at laparotomy or enteroscopy, when performed.
  
  
  RESULTS
  There was no significant difference for >10 mm polyp detection. Six polyps were found in 3 children by both modalities: 3 polyps in 2 children at CE, 3 polyps in 1 child at BE (P=0.50). Re-review of 1 CE identified 3 polyps that were missed in 1 child at initial reading. Significantly more <10 mm polyps were identified by CE than BE: 61 vs 6 (P=0.02). CE was significantly more comfortable than BE (median score CE 76 [interquartile range 69-87] vs BE 37 [interquartile range 31-68], P=0.03) and was the preferred investigation in 90% (P=0.02).
  
  
  CONCLUSIONS
  CE is a feasible, safe, and sensitive test for small bowel polyp surveillance in children with PJS. It is significantly more comfortable than BE and is the preferred test of most children for future surveillance. There is a learning curve for reporting CE studies in PJS and appropriate training is essential.
authors: Wolfson Unit for Endoscopy, St Mark's Hospital, and Department of Specialist Radiology, University College Hospital, London, UK.
authors: Aymer
authors: A
authors: Postgate
authors: Warren
authors: W
authors: Hyer
authors: Robin
authors: R
authors: Phillips
authors: Arun
authors: A
authors: Gupta
authors: David
authors: D
authors: Burling
authors: Clive
authors: C
authors: Bartram
authors: Michelle
authors: M
authors: Marshall
authors: Stuart
authors: S
authors: Taylor
authors: Gregor
authors: G
authors: Brown
authors: Gill
authors: G
authors: Schofield
authors: Paul
authors: P
authors: Bassett
authors: Christine
authors: C
authors: Spray
authors: Aine
authors: A
authors: Fitzpatrick
authors: A
authors: A
authors: Latchford
authors: Chris
authors: C
authors: Fraser
mesh_terms: D000293:Adolescent; D001464:Barium; D053704:Capsule Endoscopy / Q000379:methods*; D002648:Child; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D007417:Intestinal Polyps / Q000000981:diagnostic imaging / Q000473:pathology*; D007421:Intestine, Small / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D017060:Patient Satisfaction; D010580:Peutz-Jeghers Syndrome / Q000000981:diagnostic imaging / Q000473:pathology*; D011860:Radiography, Abdominal / Q000379:methods*; D012680:Sensitivity and Specificity; D016037:Single-Blind Method
chemical_list: D001464:Barium