Fritscher-Ravens A, Scherbakov P, Bufler P, Torroni F, Ruuska T, Nuutinen H, Thomson M, Tabbers M, Milla P
Department of Gastroenterology, Homerton University Hospital, Homerton Row, London E9 6SR, UK.
Gut. 2009 Nov;58(11):1467-72. doi: 10.1136/gut.2009.177774. Epub 2009 Jul 21.
To systematically evaluate the feasibility and methodology to carry out wireless capsule endoscopy (WCE) in children <8 years to define small intestinal pathology.
Prospective European multicentre study with negative prior investigation.
83 children aged 1.5-7.9 years were recruited. Initially, all were offered "swallowing" (Group 1) for capsule introduction. If this failed endoscopic placement (Group 2) was used and the Roth net, Advance or custom-made introducers were compared.
Primary endpoint: to determine pathology; secondary endpoint: comparison of capsule introduction methods.
Capsule introduction: 20 (24%) children aged 4.0-7.9 years (mean, 6.9 years; 14 male) comprising Group 1 were older (p<0.025) than 63 (76%) aged 1.5-7.9 years (mean, 5.25 years; 30 male) forming Group 2.
Roth net mucosal trauma in 50%; no others occurred. The available recording apparatus was inappropriate for those <3 years.
gastrointestinal bleeding: n = 30 (16 positive findings: four ulcerative jejunitis, four polyps, two angiodysplasia, two blue rubber blebs, two Meckel's diverticula, one anastomotic ulcer, one reduplication); suspected Crohn's disease: n = 20 (11 had Crohn's disease); abdominal pain: n = 12 (six positive findings: three Crohn's disease, two lymphonodular hyperplasia, one blue rubber bleb); protein loss: n = 9 (four lymphangectasia); malabsorption: n = 12 (seven positive findings: six enteropathy, one ascaris). No abnormalities overall: 45%.
WCE is feasible and safe down to the age of 1.5 years. 20 children >4 years swallowed the capsule. The Advance introducer proved superior for endoscopic placement. The pathologies encountered showed age specificity and, unlike in adolescents, obscure gastrointestinal bleeding was the commonest indication.
系统评估对8岁以下儿童进行无线胶囊内镜检查（WCE）以明确小肠病变的可行性和方法。
欧洲前瞻性多中心研究，既往检查结果为阴性。
招募了83名年龄在1.5至7.9岁的儿童。最初，所有儿童都尝试“吞咽”（第1组）胶囊以使其进入体内。如果这种方法失败，则采用内镜放置（第2组），并比较Roth网、Advance或定制导入器。
主要终点：确定病变；次要终点：比较胶囊引入方法。
胶囊引入：第1组的20名（24%）年龄在4.0至7.9岁（平均6.9岁；14名男性）儿童比第2组的63名（76%）年龄在1.5至7.9岁（平均5.25岁；30名男性）儿童年龄更大（p<0.025）。
50%的患者出现Roth网黏膜损伤；未发生其他并发症。现有的记录设备不适用于3岁以下儿童。
胃肠道出血：n = 30（16项阳性发现：4例溃疡性空肠炎、4例息肉、2例血管发育异常、2例蓝色橡皮疱痣、2例梅克尔憩室、1例吻合口溃疡、1例重复畸形）；疑似克罗恩病：n = 20（11例患有克罗恩病）；腹痛：n = 12（6项阳性发现：3例克罗恩病、2例淋巴小结增生、1例蓝色橡皮疱痣）；蛋白丢失：n = 9（4例淋巴管扩张）；吸收不良：n = 12（7项阳性发现：6例小肠病、1例蛔虫）。总体无异常：45%。
WCE在1.5岁以下儿童中是可行且安全的。20名4岁以上儿童吞咽了胶囊。Advance导入器在内镜放置方面被证明更具优势。所遇到的病变显示出年龄特异性，与青少年不同，不明原因的胃肠道出血是最常见的适应症。
