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Use of Capsule Endoscopy in Diagnosis and Management of Pediatric Patients, Based on Meta-Analysis

2011; Elsevier BV; Volume: 9; Issue: 6 Linguagem: Inglês

10.1016/j.cgh.2011.03.025

1542-7714

Stanley A. Cohen, Alan I. Klevens,

Helicobacter pylori-related gastroenterology studies

Background & AimsTo further our understanding of capsule endoscopy (CE) in children, we systematically compiled data on indications and outcomes and evaluated the effectiveness of CE on patient management using meta-analyses.MethodsWe searched the Medline and PubMed databases (January 2001–May 2010) for English language citations of use of CE in patients ≤18 years old. Duplicate reports and those that included 5 patients or fewer were removed. We analyzed data from 15 source documents with 740 CE procedures in 723 patients.ResultsSuspicion or evaluation of inflammatory bowel diseases was the most common indication for CE (54%: 34% for patients suspected to have Crohn's disease [CD], 16% for patients known to have CD, 1% for patients with ulcerative colitis, and 3% for patients with indeterminate colitis). Completion and retention rates were 86.2% (95% confidence interval [CI], 81.5–90.3) and 2.6% (95% CI, 1.5–4.0), respectively. Retention rates for children that underwent gastric (0.5%) or small bowel (1.9%) CE were similar to those of adults, by indication. For CE, 65.4% of procedures resulted in positive findings (95% CI, 54.8–75.2). Where reported, 69.4% of CE examinations (95% CI, 46.9–87.9) resulted in a new diagnosis and 68.3% (95% CI, 43.6–88.5) led to change in therapy.ConclusionsThe relative frequency of CE indications varies among pediatric and adult patients. In pediatric patients, CE is used primarily to evaluate patients with CD — to aid in diagnosis, monitor disease severity, and assist patient management. Retention rates appear to be related to indication, rather than patient age; capsule retention is relatively infrequent for adults and children. To further our understanding of capsule endoscopy (CE) in children, we systematically compiled data on indications and outcomes and evaluated the effectiveness of CE on patient management using meta-analyses. We searched the Medline and PubMed databases (January 2001–May 2010) for English language citations of use of CE in patients ≤18 years old. Duplicate reports and those that included 5 patients or fewer were removed. We analyzed data from 15 source documents with 740 CE procedures in 723 patients. Suspicion or evaluation of inflammatory bowel diseases was the most common indication for CE (54%: 34% for patients suspected to have Crohn's disease [CD], 16% for patients known to have CD, 1% for patients with ulcerative colitis, and 3% for patients with indeterminate colitis). Completion and retention rates were 86.2% (95% confidence interval [CI], 81.5–90.3) and 2.6% (95% CI, 1.5–4.0), respectively. Retention rates for children that underwent gastric (0.5%) or small bowel (1.9%) CE were similar to those of adults, by indication. For CE, 65.4% of procedures resulted in positive findings (95% CI, 54.8–75.2). Where reported, 69.4% of CE examinations (95% CI, 46.9–87.9) resulted in a new diagnosis and 68.3% (95% CI, 43.6–88.5) led to change in therapy. The relative frequency of CE indications varies among pediatric and adult patients. In pediatric patients, CE is used primarily to evaluate patients with CD — to aid in diagnosis, monitor disease severity, and assist patient management. Retention rates appear to be related to indication, rather than patient age; capsule retention is relatively infrequent for adults and children.