Guideline for wireless capsule endoscopy in children and adolescents: A consensus document by the SEGHNP (Spanish Society for Pediatric Gastroenterology, Hepatology, and Nutrition) and the SEPD (Spanish Spanish Society for Digestive Diseases)

Abstract

Introduction: Capsule endoscopy (CE) in children has limitations based mainly on age. The objective of this consensus was reviewing the scientific evidence. Material and methods: Some experts from the Spanish Society of Gastroenterology (SEPD) and Spanish Society for Pediatric Gastroenterology, Hepatology, and Nutrition (SEGHNP) were invited to answer different issues about CE in children. These sections were: a) Indications, contraindications and limitations; b) efficacy of CE in different clinical scenarios; c) CE performance; d) CE-related complications; e) Patency capsule; and f) colon capsule endoscopy. They reviewed relevant questions on each topic. Results: The main indication is Crohn's disease (CD). There is no contraindication for the age and in the event that the patient not to swallow it, it should be administered under deep sedation with endoscopy and specific device. The CE is useful in CD, for the management of OGIB in children and in Peutz-Jeghers syndrome (in this indication has the most effectiveness). The main complication is retention, which should be specially taken into account in cases of CD already diagnosed with malnutrition. A preparation regimen based on a low volume of polyethylene glycol (PEG) the day before plus simethicone on the same day is the best one in terms of cleanliness although does not improve the results of the CE procedure. Conclusions: CE is safe and useful in children. Indications are similar to those of adults, the main one is CD to establish both a diagnosis and disease extension. Moreover, only few limitations are detected in children.

Retained Wireless Capsule Endoscope in a Girl with suspected Crohn’s Disease

“…[1] The clinical application of WCE became clear in terms of pre-procedure preparation and investigations, indications, method of placement of capsule and limitations, with the consensus report from the Spanish society of gastroenterology, hepatology and nutrition published in 2015. [2] The American Society of Gastrointestinal Endoscopy guidelines state that WCE should be the first line investigation after a negative bidirectional endoscopy. [3] WCE can get retained in the GIT which is defined as non-expulsion of the capsule in the bowel for more than two weeks.…”

Contraindications for video capsule endoscopy

“…The main issue of VCE in children seems to be the ability to voluntarily swallow the capsule and the fear of the capsule not being able to pass the narrow GI tract[94]. …”

“…The youngest age of a child undergoing a VCE study was 8 mo[95], and the lowest weight was 7.9 kg[96]. Voluntary ingestion seems feasible at an age older than 6-8 years[94], and has already been reported in a child of 4 years[86]. However, the manufacturer of PillCam recommends not letting children under the age of 8 years swallow the capsule.…”

“…In patients with an increased risk of small bowel obstruction, a patency capsule test may reduce the risk of retention[97,98]. Guidelines of the Spanish Societies for Pediatric Gastroenterology, Hepatology, and Nutrition (SEGHNP) and for Digestive Diseases (SEPD) recommend that in suspected or established Crohn’s disease, magnetic resonance enterography or patency capsule should precede VCE in cases of obstruction symptoms[94]. …”

Obscure gastrointestinal bleeding and “obscure” capsule. May we switch on any lights?

“…CE soon became an effective tool in the pediatric age, where the invasiveness of conventional endoscopy always represented a real handicap. In this issue of our journal an interesting consensus paper is reported under the leadership of F. Argüelles where a group of national CE experts shed light on its use in this population (5). In contrast with the adult population, CE is most commonly indicated for the diagnosis of Crohn's disease or the assessment of Crohn's disease extension in this group.…”