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The feasibility of wireless capsule endoscopy in detecting small intestinal pathology in children under the age of 8 years – a.Multicentre European Study
  1. Annette Fritscher-Ravens (fri.rav{at}btopenworld.com)
  1. Homerton University Hospital, United Kingdom
    1. Peter Scherbakov (petersh{at}su29.ru)
    1. Academy of Medical Sciences, Moscow, Russian Federation
      1. Philip Bufler (philip.bufler{at}med.uni-muenchen.de)
      1. Childrens Hospital Munich, Germany
        1. Filipo Torroni (ftorroni{at}yahoo.it)
        1. Bambino Gesu Hospital, Italy
          1. Tarja Ruuska (tarja.ruuska{at}pshp.fi)
          1. University Hospital, Tampere, Finland
            1. Hannu Nuutinen (hannu.nuutinen{at}hus.fi)
            1. Childrens Hospital, Helsinki, Finland
              1. Michael Thomson (mike.thomson{at}sch.nhs.uk)
              1. Childrens Hospital, Sheffield, United Kingdom
                1. Merit Tabbers (m.m.tabbers{at}amc.uva.nl)
                1. Emma Childrens Hospital, Amsterdam, Netherlands
                  1. Peter Milla (p.milla{at}ich.ucl.ac.uk)
                  1. UCL Institute of Child Health, London, United Kingdom

                    Abstract

                    Objective: To systematically evaluate the feasibility and methodology to carry out wireless capsule endoscopy (WCE) in children<8 years to define small intestinal pathology.

                    Design: Prospective European Multicenter study with negative prior investigation.

                    Patients and interventions: 83 children age 1.5-7.9 years were recruited. Initially, all were offered “swallowing” (Group1) for capsule introduction. If this failed endoscopic placement (Group2) was used and Roth net, Advance™ or custom-made introducers were compared.

                    Outcome measures: Primary endpoint: to determine pathology, secondary endpoint: comparison of capsule introduction methods.

                    Results: Capsule introduction: 20 (24%) children age 4.0-7.9 years (mean: 6.9 yrs) (14 male) comprising Group 1 were older (p<0.025) than 63 (76%) age 1.5– 7.9 years (mean 5.25 yrs, 30 male) forming Gp2. Complications: Roth Net mucosal trauma in 50%; no others occurred. The available recording apparatus was inappropriate for those <3years.

                    Indications: GI bleeding: n=30 (16 positive findings:4 ulcerative jejunitis,4 polyps,2 angiodysplasia,2 blue rubber blebs, 2 Meckels diverticula,1 anastomotic ulcer,1 reduplication); suspected Crohn's disease(CD): n=20 (11 had CD); abdominal pain: n=12 (6 positive findings:3 CD, 2 lymphonodular hyperplasia, 1 blue rubber bleb); protein loss: n=9 (4 lymphangectasia); malabsorption: n=12 (7 positive findings:6 enteropathy,1 ascaris). No abnormalities overall: 45%.

                    Conclusion: WCE is feasible and safe down to the age of 1.5 years. 20 children >4 years swallowed the capsule. The Advance™ introducer proved superior for endoscopic placement. The pathologies encountered showed age specificity and unlike adolescents obscure GI bleeding was the commonest indication.

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