Efficacy of pediatric colonoscopy used as push enteroscopy in the management of capsule endoscopy findings.
BACKGROUND
recent advances in endoscopy have enabled us to explore the small intestine more efficiently, both with capsule endoscopy and double-balloon enteroscopy. However, these methods are not available in all hospitals. Therefore, when capsule endoscopy reveals proximal jejunal lesions, a possible alternative for treatment could involve push enteroscopy combined with colonoscopy. Lesions can thus be marked for subsequent monitoring.


OBJECTIVE
to describe the efficacy of pediatric colonoscopy for diagnosis, the marking of the area explored, and therapeutic options.


METHODS
between October 2007 and September 2008 a total of 21 enteroscopies were performed using a pediatric colonoscope. Nine of these were used to take jejunal biopsy samples due to suspected disease of the mucosa. In 10 of the remaining 12, capsule endoscopy revealed lesions (vascular malformations or jejunal bleeding), and in 2 intestinal transit time was analyzed due to suspected jejunal stenosis. We used a PENTAX EC-3470-LK pediatric colonoscope, whose 11.6-mm sectional diameter and 3.8-mm working channel make it possible to administer all the usual endoscopic treatments.


RESULTS
therapeutic endoscopy was performed on 7 men and 5 women (mean age 63.3 years). Jejunal lesions were observed in 10 cases (5 cases of angiodysplasia, 2 cases of jejunal stenosis, 1 case of nonmalignant thickened jejunal folds, 1 eroded submucosal tumor, and 1 case of duodenal and jejunal varices). The most distal area was marked with India ink (2), hemoclips (4), or both to help locate the lesions using simple abdominal radiography or capsule endoscopy.


CONCLUSIONS
jejunal enteroscopy enabled a firm diagnosis to be made in most of the patients studied. We were able to treat 58% of patients and mark the areas explored for subsequent follow-up. With hemoclips we were able to locate the most distal point explored using simple abdominal radiography.
Pérez Roldán
F
F
Service of Digestive Diseases, Hospital General La Mancha-Centro, Alcázar de San Juan, Ciudad Real, Spain. fperezroldan@gmail.com
González Carro
P
P
Legaz Huidobro
M L
ML
Roncero García-Escribano
O
O
Ynfante Ferrús
M
M
Aoufi
S
S
Sánchez-Manjavacas Muñoz
N
N
Ruiz Carrillo
F
F
D000328:Adult; D000368:Aged; D053704:Capsule Endoscopy; D020685:Colonoscopes; D003113:Colonoscopy / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007579:Jejunal Diseases / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies