Capsule Endoscopy Is Feasible in Small Children

Capsule endoscopy was recently introduced for endoluminal visualization of the small bowel [1]. The clinical utility of the procedure is undisputed [2] [3] [4], and for most patients, swallowing the capsule (11 × 33 mm in size) does not pose any problems. However, use of the capsule in small children has not yet been reported.

A 3-year-old boy was admitted to our hospital with chronic iron-deficiency anemia and tarry stools. The hemoglobin level had ranged from 3.4 to 10.3 over a 2-year period, despite continuous iron replacement therapy. Upper and lower endoscopy, computed tomography of the abdomen, Meckel scintigraphy, and a small-bowel follow-through had all been unremarkable.

Capsule endoscopy was carried out with the patient under general anesthesia. The capsule was grasped in a polypectomy snare through the endoscope and pushed through the upper esophageal sphincter. The capsule was placed in the duodenal bulb, to avoid the risk of gastric retention of a capsule this size. After 54min (approximately 30min after release), a large polypoid tumor without ongoing bleeding was clearly visualized (Figure [1]). The rest of the small bowel was normal, with passage of the cecum after a total time of 4 min 50 s.

Figure 1 Capsule image showing a polypoid lesion in the jejunum, causing partial obstruction of the lumen.

Based on the capsule endoscopy finding, a minilaparotomy was performed, and a tumor 17 × 15 mm in size was found and resected in the suspected part of the jejunum, 100 cm from the ligament of Treitz (Figure [2]). Histology showed that the lesion consisted of hamartomatous tissue, without no sign of malignancy. The postoperative course was uneventful, with no recurrence of anemia.

Figure 2 The resected specimen, a 17 × 15 mm hamartomatous polyp.

This case illustrates the feasibility of capsule endoscopy even in small children, using an endoscope to insert the capsule. It also shows the low sensitivity of small-bowel follow-through studies in detecting small to moderate-sized tumors in the small bowel.

References

• 1 Gavriel Iddan G, Meron G, Glukhovsky A. et al . Wireless capsule endoscopy.  Nature. 2000;  405 417
• 2 Ell C, Remke S, May A. The first prospective controlled trial comparing wireless capsule endoscopy with push enteroscopy in chronic gastrointestinal bleeding.  Endoscopy. 2002;  34 685-689
• 3 Lewis B S. Enteroscopy: endangered by the capsule?.  Endoscopy. 2002;  34 416-417
• 4 Lewis B S, Swain P. Capsule endoscopy in the evaluation of patients with suspected small intestinal bleeding: results of a pilot study.  Gastrointest Endosc. 2002;  56 452-456