NEW YORK (Reuters Health), Nov 11 - Wireless capsule endoscopy is feasible for detecting small intestinal pathology in children younger than 8 years old, according to a report in the November Gut. However, most children in this age group are unable to swallow the small device, so it needs to be introduced endoscopically.
"Capsule endoscopy is a suitable means for diagnostic purposes in young children whose symptoms cannot be explained otherwise," Dr. Annette Fritscher-Ravens from University Hospital Kiel, Germany, told Reuters Health. "Despite the quite large size of the capsule, this can pass the entire gastrointestinal tract, which makes an evaluation of the small bowel possible without pain and exposure to a high complication rate."
Dr. Fritscher-Ravens and colleagues evaluated the feasibility of this technique for defining small intestinal pathology in 83 children aged 1.5 to 7.9 years. The smallest child weighed 10 kg.
Wireless capsule endoscopy identified a source of bleeding in 16 of 30 children with obscure gastrointestinal bleeding and/or chronic anemia, evidence of small intestinal Crohn's disease in 11 of 20 children suspected of having the disease, significant pathology in 6 of 12 children with recurrent abdominal pain and 6 of 9 children with protein-losing enteropathy, and varying degrees of villous atrophy in 6 of 12 children with malabsorption.
Four studies in three children were incomplete, the authors report, but relevant diagnostic information was obtained in two of these children.
About a quarter of the children were able to swallow the capsule, while the remaining three quarters had the capsule endoscopically introduced into the duodenum.
Capsule retention did not occur in any examination, the investigators say.
"More than with adults, in children one has to weigh the benefits of a diagnostic test with the cost of complications to be expected," Dr. Fritscher-Ravens explained. "This is a very good ratio with capsule endoscopy, as the only expected complication is that it can get stuck, when there is a stricture in the small bowel. But this incident is then also the reason for the complaint. It is also very rare."
By Will Boggs, MD
Gut 2009;58:1467-1472.
Last Updated: 2009-11-10 14:10:09 -0400 (Reuters Health)
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