Capsule endoscopy performed across the pediatric age range: indications, incomplete studies, and utility in management of inflammatory bowel disease.
BACKGROUND
Capsule endoscopy (CE) is used increasingly to evaluate the small bowel in children. An upper GI series is recommended before CE to evaluate the risk of obstruction. Despite normal findings on an upper GI series, CE may still be incomplete. Although large adult studies have demonstrated the safety and diagnostic yield of CE, similar pediatric studies have not been available.


OBJECTIVE
To identify factors associated with incomplete studies and the diagnostic yield in pediatric patients.


METHODS
Retrospective review of consecutive CE studies from February 2005 through June 2008.


METHODS
Large tertiary children's hospital.


METHODS
A total of 123 CE studies in 117 patients; median age 12.9 years (range 0.8-22.4 years).


METHODS
Demographic information, indication, placement technique, pre-CE imaging results, and cecal completion status were recorded. Risk factors were analyzed with bivariate and multivariate regression analysis.


RESULTS
There were 27 (22%) incomplete studies; of these, there were normal pre-CE radiologic study findings in 12 (44%), and findings requiring medical, endoscopic, or operative intervention in 6. Of the 117 patients, CE produced a new diagnosis in 21 (18%). Abnormal findings on previous imaging (odds ratio [OR] 3.0; 95% CI, 1.2-8.0), endoscopic placement (OR 3.1; 95% CI, 1.1-8.4), and female sex (OR 3.3; 95% CI, 1.2-9.4) were associated with incomplete studies.


CONCLUSIONS
Retrospective, incomplete follow-up.


CONCLUSIONS
CE may be performed in children as small as 11.5 kg, with 18% yield in all studies, and 28% in pediatric known inflammatory bowel disease. Capsule retention requiring retrieval did not pose life-threatening risk in our series, and CE may be used to identify disease-associated small-bowel stenosis.
Jensen
M Kyle
MK
Division of Pediatric Gastroenterology, Medical College of Wisconsin/Children's Hospital of Wisconsin, Milwaukee, Wisconsin 53226, USA.
Tipnis
Neelesh A
NA
Bajorunaite
Ruta
R
Sheth
Mehul K
MK
Sato
Thomas T
TT
Noel
Richard J
RJ
D000293:Adolescent; D053704:Capsule Endoscopy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003093:Colitis, Ulcerative / Q000175:diagnosis*; D003424:Crohn Disease / Q000175:diagnosis*; D020878:Device Removal; D004868:Equipment Failure; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D007415:Intestinal Obstruction / Q000175:diagnosis*; D008202:Lymphangioma / Q000175:diagnosis*; D008297:Male; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013921:Thrombocytopenia / Q000175:diagnosis*; D055815:Young Adult