Capsule endoscopy safe in small children

Wireless capsule endoscopy (WCE) is safe, practical and useful in children as young as 18 months, a multicentre European study has shown. Gastroenterologists in nine hospitals successfully applied WCE in 83 children aged from 1.5 to 7.9 years. Indications for the examination included occult GI bleeding, suspected Crohn’s disease, abdominal pain of unknown cause, protein-losing enteropathy and malabsorptive disorders, and negative results from a standard barium meal and/or endoscopy. With sufficient coaxing, about 25% of children older than four were able to swallow the WCE device. The remainder required the device to be placed endoscopically. Endoscopists initially were able to use their method of choice, but the Roth Net introducer caused unacceptable mucosal trauma and was abandoned in favour of the Advance introducer. There were no other adverse effects associated with WCE. Abnormalities were found in 55% of patients. In 30 cases of GI bleeding, for example, four patients had ulcerative jejunitis and four had polyps, and ten had other abnormalities including angiodysplasia and Meckel’s diverticula. “Investigations in small children always require special consideration compared to adults,” the gastroenterologists noted. “Their understanding of procedures is limited, their fear of a foreign environment is large, some agents such as X-ray are potentially damaging, and devices and instruments are often not suitable.” Gut 2009; published online....