title: Video capsule endoscopy impacts decision making in pediatric IBD: a single tertiary care center experience.
abstract: BACKGROUND
  Little is known about the impact of video capsule endoscopy (VCE) on decision making in pediatric patients with IBD. Moreover, few studies have reported on the outcomes of treatment changes made based on VCE findings. Our aim was to identify the added value of VCE in pediatric patients in a tertiary IBD center with established or suspected IBD, by assessing changes in treatments and outcomes before and after VCE.
  
  
  METHODS
  A retrospective chart review was performed in children with established (n = 66) or suspected (n = 17) IBD who underwent VCE. Diagnostic classifications, treatments, and clinical outcomes before and 1 year after VCE were compared.
  
  
  RESULTS
  Primary indications for VCE included patients treated for Crohn's disease (CD) with poor growth or active symptoms (60%), patients with ulcerative colitis/IBD-unclassified (19%), and suspected IBD (20%). Abnormal VCE was seen in 86% of patients with CD, of whom 75% underwent treatment escalation. One year after VCE, patients with CD improved in growth (mean z-scores at baseline and 12 months, -0.5 and 0.2, respectively; P < 0.0001), mean body mass index (18.3 and 19.8, respectively; P = 0.004), mean erythrocyte sedimentation rate (25 versus 16, respectively; P = 0.012), and median Harvey-Bradshaw Index (2 and 0, respectively; P = 0.003). VCE revealed more extensive disease than concurrent imaging modalities in 43% of the patients with CD. VCE "ruled out" IBD in 94% who had suspected IBD, whereas 50% with presumed ulcerative colitis/IBD-unclassified had a diagnosis changed to CD.
  
  
  CONCLUSIONS
  VCE provides additional clinical information that impacted management of pediatric patients with IBD in a tertiary IBD center and was associated with improved outcomes.
authors.affiliation: Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA. steven.min@gmail.com
authors.forename: Steve B
authors.initials: SB
authors.lastname: Min
authors.forename: Minou
authors.initials: M
authors.lastname: Le-Carlson
authors.forename: Namita
authors.initials: N
authors.lastname: Singh
authors.forename: Cade M
authors.initials: CM
authors.lastname: Nylund
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gebbia
authors.forename: Kelly
authors.initials: K
authors.lastname: Haas
authors.forename: Simon
authors.initials: S
authors.lastname: Lo
authors.forename: Neel
authors.initials: N
authors.lastname: Mann
authors.forename: Gil Y
authors.initials: GY
authors.lastname: Melmed
authors.forename: Shervin
authors.initials: S
authors.lastname: Rabizadeh
authors.forename: Marla C
authors.initials: MC
authors.lastname: Dubinsky
mesh_terms: D000293:Adolescent; D053704:Capsule Endoscopy; D002648:Child; D003093:Colitis, Ulcerative / Q000175:diagnosis* / Q000628:therapy; D003424:Crohn Disease / Q000175:diagnosis* / Q000628:therapy; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D062606:Tertiary Care Centers