The concept of a wireless capsule endoscope for the investigation of the small bowel was introduced in 2000. This research tool was soon followed by a commercially available product both in Europe and the U.S. Capsule endoscopy has been demonstrated to be safe and well tolerated in patients with symptoms consistent with diseases of the small intestine and previous negative upper endoscopy and colonoscopy.
Specific uses of capsule endoscopy in children vary. Capsule endoscopy has proven helpful in identifying intestinal inflammation, Crohn’s disease, celiac disease, occult or obscure intestinal bleeding, vascular malformations, vasculitis (Henoch- Schönlein Purpura), Meckel’s diverticulum, protein-losing enteropathies, intestinal lymphangiectasia, Peutz-Jeghers syndrome, polyposis syndromes, eosinophilic enteropathy, other iatrogenic causes of mucosalury (chemotherapy, radiotherapy, graft versus host disease).
According to Alan D. Baldridge, MD, Division Head of Pediatric Gastroenterology at Children’s Regional Hospital at Cooper, capsule endoscopy is superior to small-bowel radiography, computed tomography enterography, and colonoscopy with ileoscopy in the evaluation of Crohn’s disease.
Dr. Baldridge reports, “Capsule endoscopy is more sensitive than radiological and standard endoscopic modalities in the detection and definition of small bowel Crohn’s disease distribution, occult gastrointestinal bleeding source, and presence of polyps in children. Surprisingly, even if the initial study is non-diagnostic, repeat capsule endoscopy may increase diagnostic yield. Even in children as young as eighteen months, capsule endoscopy can detect small intestinal pathology when the indications are gastrointestinal bleeding, suspected Crohn’s disease, abnormal pain, protein loss and malabsorption.”
Few incidents of retention of the capsule among pediatric patients have been reported; therefore, capsule endoscopy is considered feasible and safe in patients as young as 1½ years of age. Swallowing of the capsule can be a problem in many children. Most patients older than 10 years of age can ingest the capsule; in children between 4 years of age and 10 years of age, about one-third can swallow the capsule.
“Endoscopic placement of the capsule into the duodenum is used when children are unable to ingest the capsule,” says Dr. Baldridge. “During endoscopic placement, the capsule is released at the third part of the duodenum in order to prevent retrograde migration into the stomach. Though rare, the most significant complication is retention of the capsule, which requires surgery to remove. Though required as part of the evaluation prior to capsule placement, a normal upper gastrointestinal/small bowel follow through examination does not preclude subsequent capsule retention.”
Capsule endoscopy is a very useful diagnostic tool, but is not indicated with known or suspected gastrointestinal obstruction, stricture or fistulas. Patients with pacemakers or implanted electro-medical devices also should not have capsule endoscopy.
“Capsule endoscopy is a non-invasive, effective approach to investigate the entire small intestine compared to the conventional examination methods of enteroscopy and enterography,” says Dr. Baldridge. “It provides evidence for the diagnosis and gives supportive information regarding the effectiveness of treatment and clinical course.”
Dr. Baldridge and his colleague Kimberly Isola, MD perform these endoscopic procedures for pediatric patients in Cooper’s Surgical Center in Voorhees, as well as Cooper University Health Care’s main campus in Camden.