Guilhon de Araujo Sant'Anna Ana Maria, Dubois Josée, Miron Marie-Claude, Seidman Ernest G
Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Sainte-Justine Hospital, University of Montréal, Montréal, Québec, Canada.
Clin Gastroenterol Hepatol. 2005 Mar;3(3):264-70. doi: 10.1016/s1542-3565(04)00715-3.
Obscure small-bowel disorders are jejunal and ileal lesions undiagnosed by traditional imaging techniques (endoscopic, radiologic). We evaluated the diagnostic usefulness and safety of capsule endoscopy for obscure small-bowel disorders in children and adolescents.
Comparative, prospective, self-controlled trials in patients (age, 10-18 y) suspected to have either small-bowel Crohn's disease, polyps, or obscure gastrointestinal (GI) bleeding. Capsule results were compared with the diagnostic imaging studies normally used in this age group.
Among 20 patients suspected of Crohn's disease, multiple lesions consistent with this diagnosis were observed by capsule endoscopy in 50%. Small-bowel Crohn's disease was ruled out in 8 patients. Eosinophilic enteropathy was found in 2 others. For polyp detection (n = 6), capsule endoscopy yielded 100% concordance with the control studies when analyzed per patient. However, capsule endoscopy revealed a greater number (50%) of polyps. Among patients with obscure bleeding (n = 4), the capsule examination confirmed a diagnosis of vascular malformations in 3. Capsule endoscopy more accurately identified the precise source of bleeding compared with angiography. All 30 capsule studies were well tolerated, although 1 capsule was retained owing to an inflammatory stenosis. The capsule eventually was expelled after corticosteroid therapy.
Capsule endoscopy correctly diagnosed or excluded a bleeding source, small-bowel polyps, or Crohn's disease of the small bowel in 29 of 30 patients. Capsule endoscopy permits an accurate, noninvasive approach for diagnosing obscure small bowel lesions in children over the age of 10.
隐匿性小肠疾病是指传统成像技术（内镜、放射学）无法诊断的空肠和回肠病变。我们评估了胶囊内镜对儿童和青少年隐匿性小肠疾病的诊断价值和安全性。
对疑似患有小肠克罗恩病、息肉或隐匿性胃肠道出血的患者（年龄10 - 18岁）进行对比、前瞻性、自身对照试验。将胶囊内镜检查结果与该年龄组通常使用的诊断性影像学检查结果进行比较。
在20例疑似克罗恩病的患者中，胶囊内镜观察到符合该诊断的多处病变的患者占50%。8例患者排除了小肠克罗恩病。另外2例发现嗜酸性粒细胞性小肠病。对于息肉检测（n = 6），按患者分析时，胶囊内镜与对照研究结果的一致性为100%。然而，胶囊内镜发现的息肉数量更多（50%）。在隐匿性出血患者（n = 4）中，胶囊内镜检查确诊3例为血管畸形。与血管造影相比，胶囊内镜更准确地确定了出血的精确来源。所有30例胶囊内镜检查耐受性良好，尽管有1例因炎症性狭窄导致胶囊滞留。经皮质类固醇治疗后，胶囊最终排出。
30例患者中有29例通过胶囊内镜正确诊断或排除了出血源、小肠息肉或小肠克罗恩病。胶囊内镜为诊断10岁以上儿童隐匿性小肠病变提供了一种准确、无创的方法。
