Capsule Endoscopy in Children: Overall Usefulness and Special Value in Intestinal Crohn's Disease

Abstract

Objective: To review the experience with Capsule Endoscopy (CE) in pediatric population at a tertiary care center focusing on the utility of CE to diagnose small bowel Crohn's disease and assess disease activity. Methods: Thirty four patients aged less than 20 years underwent capsule endoscopy at the Jefferson Digestive Diseases Institute, Philadelphia, PA, for a total of 36 studies between May, 2004 to September, 2006. Pillcam SB (Given Imaging, Yoqneam, Israel) capsule was used in all studies. Medical records were reviewed for demographic data, pre-procedure diagnosis, indications, number of complete and incomplete examinations, gastric and small bowel transit times, findings and complications of CE. Results: Two patients failed to complete the study secondary to retention of capsule in the stomach; requiring endoscopic removal in one case and resulting in vomiting of the capsule in other. These patients were excluded from final analysis which represents experience from 32 patients and 34 studies. Mean age of patients was 14 years (Range:7-19 years). Females comprised 62.5% of all patients. Indications included abdominal pain (19 of 34, 56% studies), GI bleeding (47%), diarrhea (41%), anemia (35%) and weight loss/failure to thrive (9%). Capsule was easily swallowed by all patients. Mean gastric transit time was 42 minutes. Capsule failed to visualize the cecum in 18% studies. All 34 capsules were excreted spontaneously and no complications like abdominal pain, bowel obstruction or bleeding were observed. Abnormal findings were seen in 25 of 34 (74%) studies. Crohn's disease activity, in the form of aphthae, linear and serpiginous ulcers, and fissures involving distal small bowel was visualized in 3 of 5 (60%) patients with already diagnosed Crohn's disease involving small and/or large intestine. Four patients who were overall negative for Crohn's disease using conventional radiographic and endoscopic studies had diagnostic findings consistent with Crohn's disease on CE. These findings were most commonly located in the ileum, but also involved duodenum and jejunum. Other abnormal capsule findings included erythema (in 21% of 34 studies), erosions (18%), fresh blood (15%), ulcers (15%), gastritis (15%) and mucosal fold thickening (12%). Conclusion:A) Capsule endoscopy is a safe and valuable diagnostic tool in pediatric population with a potential to expedite diagnosis and treatment of small bowel disease similar to the adult experience. B) Capsule endoscopy is especially useful in detecting the presence, activity and severity of small bowel Crohn's disease. C) Capsule endoscopy offers the possibility of improved diagnosis while limiting radiation exposure in children with Crohn's disease.