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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