The feasibility of wireless capsule endoscopy in detecting small intestinal pathology in children under the age of 8 years: a multicentre European study.
OBJECTIVE
To systematically evaluate the feasibility and methodology to carry out wireless capsule endoscopy (WCE) in children <8 years to define small intestinal pathology.


METHODS
Prospective European multicentre study with negative prior investigation.


METHODS
83 children aged 1.5-7.9 years were recruited. Initially, all were offered "swallowing" (Group 1) for capsule introduction. If this failed endoscopic placement (Group 2) was used and the Roth net, Advance or custom-made introducers were compared.


METHODS
Primary endpoint: to determine pathology; secondary endpoint: comparison of capsule introduction methods.


RESULTS
Capsule introduction: 20 (24%) children aged 4.0-7.9 years (mean, 6.9 years; 14 male) comprising Group 1 were older (p<0.025) than 63 (76%) aged 1.5-7.9 years (mean, 5.25 years; 30 male) forming Group 2.


RESULTS
Roth net mucosal trauma in 50%; no others occurred. The available recording apparatus was inappropriate for those <3 years.


METHODS
gastrointestinal bleeding: n = 30 (16 positive findings: four ulcerative jejunitis, four polyps, two angiodysplasia, two blue rubber blebs, two Meckel's diverticula, one anastomotic ulcer, one reduplication); suspected Crohn's disease: n = 20 (11 had Crohn's disease); abdominal pain: n = 12 (six positive findings: three Crohn's disease, two lymphonodular hyperplasia, one blue rubber bleb); protein loss: n = 9 (four lymphangectasia); malabsorption: n = 12 (seven positive findings: six enteropathy, one ascaris). No abnormalities overall: 45%.


CONCLUSIONS
WCE is feasible and safe down to the age of 1.5 years. 20 children >4 years swallowed the capsule. The Advance introducer proved superior for endoscopic placement. The pathologies encountered showed age specificity and, unlike in adolescents, obscure gastrointestinal bleeding was the commonest indication.
Fritscher-Ravens
A
A
Department of Gastroenterology, Homerton University Hospital, Homerton Row, London E9 6SR, UK. fri.rav@btopenworld.com
Scherbakov
P
P
Bufler
P
P
Torroni
F
F
Ruuska
T
T
Nuutinen
H
H
Thomson
M
M
Tabbers
M
M
Milla
P
P
D015746:Abdominal Pain / Q000209:etiology; D016888:Angiodysplasia / Q000175:diagnosis*; D053704:Capsule Endoscopy / Q000009:adverse effects / Q000379:methods; D002648:Child; D002675:Child, Preschool; D003424:Crohn Disease / Q000175:diagnosis*; D005060:Europe; D005240:Feasibility Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D007223:Infant; D008286:Malabsorption Syndromes / Q000209:etiology; D008297:Male; D008467:Meckel Diverticulum / Q000175:diagnosis*; D011504:Protein-Losing Enteropathies / Q000175:diagnosis; D016896:Treatment Outcome