Capsule endoscopy performed across the pediatric age range: indications, incomplete studies, and utility in management of inflammatory bowel disease

Background

Capsule endoscopy (CE) is used increasingly to evaluate the small bowel in children. An upper GI series is recommended before CE to evaluate the risk of obstruction. Despite normal findings on an upper GI series, CE may still be incomplete. Although large adult studies have demonstrated the safety and diagnostic yield of CE, similar pediatric studies have not been available.

Objective

To identify factors associated with incomplete studies and the diagnostic yield in pediatric patients.

Design

Retrospective review of consecutive CE studies from February 2005 through June 2008.

Setting

Large tertiary children's hospital.

Patients

A total of 123 CE studies in 117 patients; median age 12.9 years (range 0.8-22.4 years).

Main Outcome Measurements

Demographic information, indication, placement technique, pre-CE imaging results, and cecal completion status were recorded. Risk factors were analyzed with bivariate and multivariate regression analysis.

Results

There were 27 (22%) incomplete studies; of these, there were normal pre-CE radiologic study findings in 12 (44%), and findings requiring medical, endoscopic, or operative intervention in 6. Of the 117 patients, CE produced a new diagnosis in 21 (18%). Abnormal findings on previous imaging (odds ratio [OR] 3.0; 95% CI, 1.2-8.0), endoscopic placement (OR 3.1; 95% CI, 1.1-8.4), and female sex (OR 3.3; 95% CI, 1.2-9.4) were associated with incomplete studies.

Limitations

Retrospective, incomplete follow-up.

Conclusions

CE may be performed in children as small as 11.5 kg, with 18% yield in all studies, and 28% in pediatric known inflammatory bowel disease. Capsule retention requiring retrieval did not pose life-threatening risk in our series, and CE may be used to identify disease-associated small-bowel stenosis.

Abbreviations: CD, Crohn's disease, CE, capsule endoscopy, IBD, inflammatory bowel disease, IC, indeterminate colitis, OR, odds ratio, OGIB, occult GI bleeding, SBO, small-bowel obstruction