Department of Pediatrics, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan.
J Gastroenterol. 2010 Jul;45(7):683-91. doi: 10.1007/s00535-010-0209-5. Epub 2010 Feb 9.
The aim of our study was to determine the safety and usefulness of capsule endoscopy (CE) in pediatric patients.
We prospectively examined children (aged 10-18 years) with suspected small bowel disease and recorded capsule transit times, findings, and complications.
We performed 19 CE examinations in 12 patients (median age 11.8 years; range 10-18 years). One of the two patients with obscure gastrointestinal bleeding (OGIB), a 14-year-old girl whose OGIB occurred after cord-blood transplantation due to leukemia, was diagnosed with thrombotic microangiopathy. Repeated CE allowed visualization of real-time mucosal changes, such as the improvement of ulcers and bleeding, and newly emerged lymphangiectasia, without causing the patient physical and mental stress. This information facilitated both subsequent evaluation of the clinical course and determination of the appropriate treatment strategy. In the second patient with chronic OGIB, a 10-year-old girl, the detection of severe ileal stenoses by capsule retention led to the diagnosis of non-specific multiple ulcers of the small intestine. After ileal resection, repeated CE detected the recurrence of multiple ulcers and enabled the optimal treatment strategy to be applied. CE confirmed small bowel involvement in a patient with unresponsive Crohn's disease (CD) and excluded CD in all five patients with suspected CD. Similarly, CE confirmed the absence of small bowel involvement in three of the four patients with recurrent abdominal pain, although one patient had nodular lymphoid hyperplasia.
Based on our results, CE is a valuable tool in the differential diagnoses of small bowel diseases, and repeated examination can provide real-time information that will enable evaluation of the clinical course in pediatric patients.
本研究旨在确定胶囊内镜（CE）在儿科患者中的安全性和实用性。
我们前瞻性地检查了疑似小肠疾病的儿童（年龄 10-18 岁），并记录了胶囊通过时间、检查结果和并发症。
我们对 12 例患者（中位年龄 11.8 岁；范围 10-18 岁）进行了 19 次 CE 检查。2 例不明原因胃肠道出血（OGIB）患者中的 1 例为 14 岁女孩，OGIB 是由于白血病在脐带血移植后发生血栓性微血管病引起的。重复 CE 可以实时观察黏膜变化，如溃疡和出血的改善以及新出现的淋巴管扩张，而不会给患者带来身心压力。这些信息有助于后续评估临床过程并确定适当的治疗策略。在第二例慢性 OGIB 患者（10 岁女孩）中，胶囊滞留检测到严重的回肠狭窄，导致诊断为小肠非特异性多发性溃疡。回肠切除后，重复 CE 检测到多发性溃疡复发，并能应用最佳治疗策略。CE 确认了一名对治疗无反应的克罗恩病（CD）患者的小肠受累，并排除了所有 5 名疑似 CD 患者的 CD。同样，CE 确认了 4 名复发性腹痛患者中有 3 名无小肠受累，尽管其中 1 名患者有结节性淋巴组织增生。
根据我们的结果，CE 是一种有价值的小肠疾病鉴别诊断工具，重复检查可以提供实时信息，有助于评估儿科患者的临床过程。
