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.
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.
Postgate
Aymer
A
Wolfson Unit for Endoscopy, St Mark's Hospital, and Department of Specialist Radiology, University College Hospital, London, UK.
Hyer
Warren
W
Phillips
Robin
R
Gupta
Arun
A
Burling
David
D
Bartram
Clive
C
Marshall
Michelle
M
Taylor
Stuart
S
Brown
Gregor
G
Schofield
Gill
G
Bassett
Paul
P
Spray
Christine
C
Fitzpatrick
Aine
A
Latchford
A
A
Fraser
Chris
C
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
D001464:Barium