#10 Capsule Endoscopy for Diagnosis of Pediatric GI Disorders

Overview

One of the most challenging problems in pediatric digestive medicine is finding the source of hidden bleeding
in the gastrointestinal (GI) tract. Problems in the esophagus and stomach can be diagnosed with traditional
gastroduodenoscopy and large intestine problems can be uncovered with colonoscopy. Until recently, however,
when traditional endoscopic imaging techniques using a fiber optic scope or x-ray failed to reveal the source of
unexplained bleeding in the area between the stomach and colon, surgery was often a next step.

Now there is a safe and painless alternative that can uncover many pediatric GI problems. For these difficultto-
diagnose cases, many doctors are turning to a high-tech imaging tool called video capsule endoscopy for its
detailed high-resolution images of the entire small intestine, an area that is one of the most difficult parts of the
GI tract to view with traditional procedures.

It all starts by having the child swallow the pill-sized capsule that has the miniature camera inside. This state-of-the-art tool that barely weighs 1/7th of an ounce is easy to swallow with a sip of water, cannot be damaged by
the powerful digestive enzymes of the stomach, requires no air insufflation or sedation, and is painless and safe.

The single-use wireless camera in the tiny capsule takes thousands of color pictures and short video clips
of the insides of the digestive tract during its travels as it’s pushed along by the peristaltic activity of the
intestine’s involuntary muscles. During the course of the six-to eight-hour journey, more than 50,000 images
are eventually transmitted to a small data recorder that is worn around the waist and later downloaded to a
computer for careful review.

Since the quality of the color images is so high, the technology is better than x-rays for detecting small-bowel
ulcerations, polyps, and areas of bleeding. And once the source of the problem is finally detected, follow-up
treatment can then be initiated.

First approved by the Food and Drug Administration for use in adults in 2001, official approval of wireless capsule endoscopy for pediatric patients was later granted based on a 2005 study that reported that the newer capsule examination revealed significantly more gastrointestinal abnormalities than did traditional imaging techniques.

In half of the 20 patients with suspected small-bowel Crohn’s disease, the capsule study uncovered multiple smallbowel lesions, confirming the diagnosis. Eight remaining patients were found not to have Crohn’s disease, while the remaining two were found to have a rare disorder of the digestive tract called eosinophilic enteropathy.

By contrast, colonoscopy findings were normal in 15 of the 20 patients suspected of having Crohn’s, and were not conclusive for a Crohn’s diagnosis in the remaining five patients.

Capsule endoscopies are now used to accurately and non-invasively diagnose a range of problems in the pediatric digestive tract. In addition to Crohn’s disease, the device can help uncover Celiac disease and other absorption disorders, tumors of the small intestine, and injuries to the bowel. The video capsule is also being used to assessongoing medical therapy in the GI tract, and as a way to definitively rule out the small intestine as the source of medical problems.

Where Are They Now

One of the most challenging problems in pediatric digestive medicine is finding the source of hidden bleeding in the gastrointestinal (GI) tract. When traditional endoscopic imaging techniques using a fiber optic scope or x-ray failed to reveal the source of unexplained bleeding in the area between the stomach and colon, surgery was often a next step. However, for these difficult-to-diagnose cases, many doctors are turning to a high-tech imaging tool called video capsule endoscopy for its detailed high-resolution images of the entire small intestine, an area that is one of the most difficult parts of the GI tract to view with traditional procedures. It all starts by having the child swallow the pill-sized capsule that has the miniature camera inside.

Capsule endoscopy is becoming a standard method of assessing pediatric GI disorders. In one recent study, use of a capsule endoscopy led to a new diagnosis and change of therapy in nearly 70% of patients. Innovation continues to refine the technique: In 2011, Japanese researchers developed a self-propelled endoscopy capsule. In 2015, Wi-Fi enabled capsules became available. Current research is attempting to create bigger capsules that are able to thoroughly image the large intestine, possibly replacing the need for colonoscopies in the future. In 2016, the capsule endoscopy market expanded and has found its niche in inspecting some portions of the intestinal system, mainly the small intestine. The device is still considered relatively new, but physicians believe it is useful in diagnostic procedures where colonoscopies haven’t been able to explore before.   

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