Endoscopy :: Endoscopy to detect Small Intestinal Pathology in Young Children

Many medical procedures and devices used to detect problems or disease in adults have not been tested, and therefore are not used, in children.

While all procedures and devices used in adults may not be appropriate for use in children, some may lead to increased understanding of disease pathology and better diagnosis of certain disorders in the pediatric population.

Wireless Capsule Endoscopy (WCE) is not widely used in small children (no FDA approval for children <10) due to inherent problems in swallowing the capsule. To overcome this difficulty, some investigators have used adult introducer devices to endoscopically place the capsule into the gut. These methods are cumbersome and potentially traumatizing.Researchers from children’s hospitals throughout Europe tested the use of WCE in small children as a means of investigating the small intestine (SI), which is difficult to examine thoroughly with other endoscopic procedures. WCE utilizes a video capsule that, once swallowed, travels through the SI to acquire and transmit digital images. The study aimed to determine the ability of WCE in children <8 years of age, to compare endoscopic means of introduction, and to define the pathologies encountered to evaluate the need for capsule endoscopy in this age group.The multi-center trial enrolled 56 patients ranging from age one and a half to eight. All patients underwent barium meal and follow through, and upper and lower gastrointestinal (GI) tract endoscopy prior to enrollment. After 12 hours of fasting, patients were given the capsules. Twenty-three were able to swallow the capsule easily, and 33 required endoscopic introduction.The capsule procedure was successful in all patients down to the age of one and a half. The images revealed important age-specific disorders, including suspected GI bleeding (n=23), Crohn’s disease (n=15), abdominal pain (n=10) and protein loss (n=8). One adult endoscopic introducer proved to be quite traumatizing, yet important information in developing pediatric use was determined. The size of the capsule was too large and the weight of the batteries too excessive for the youngest children involved in the trial.“This preliminary data shows that wireless capsule endoscopy is a viable and safe means of examining the small intestine in very young children and confirms the utility of this practice in detecting occult gastrointestinal bleeding in children, which has been a challenge in the past,” said Annette Fritscher-Ravens, M.D., of Homerton University Hospital in London, UK, and lead author of the study. “Additional studies are needed to further validate the safety and efficacy of this practice, as it will lead to increased knowledge and earlier diagnosis of gastrointestinal problems in this age group.”

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