Capsule Endoscopy in a Series of Preschool Age Children with Obscure Gastrointestinal Bleeding

Abstract

Background: Capsule endoscopy (CE) has been demonstrated to be safe and well tolerated when used in the assessment of pediatric gastrointestinal disease. Current data on CE in children has been limited to information from studies on children over the age of 9 years. It has been suggested that its use in younger children may need to be restricted due to the potential for retention of the capsule due to an inability to pass through a smaller lumen of the pediatric gastrointestinal tract. Methods/Results: Three children underwent CE, ages 2.1, 2.5 and 4 years, with obscure GI bleeding. Two patients had biliary atresia and had undergone a Kasai portoenterostomy with creation of a Roux en Y loop in infancy. The other child had a history of dyskeratosis congenita and had a bone marrow transplant. All patients had undergone standard workup including EGD and colonoscopy that did not reveal the source of the bleeding. In each patient, the PillCam™ SB (Given Imaging) capsule was placed with the aid of a gastroscope under general anesthesia without complications. In two patients, a polyp retrieval device mounted at the tip of the gastroscope was used to place the capsule in the duodenum. The entire small bowel was visualized in two patients. One procedure was incomplete with the capsule located in the jejunum at the end of study period. No signs of bowel obstruction presented at any point during the study. In all patients, the capsule was identified in the patient's stool within 24 hours after initiating the procedure. Small intestinal lesions consistent with a source for GI bleeding were found in all patients. These included portal hypertensive enteropathy in the first patient, single jejunal hemangioma in the second, and jejunal angiodysplasia in the third patient. All the CE procedures were tolerated well without any adverse events. Conclusion: This is the first reported series of patients in this young age group to have undergone capsule endoscopy. The capsule passed readily through the GI tract in these children and provided valuable clinical data. This experience suggests that CE may be a safe and effective diagnostic tool in the evaluation of small bowel disease in preschool age children. Further study is warranted to validate the utility of CE in this population.