Capsule Endoscopy Is Feasible in Small Children

Capsule endoscopy was recently introduced for endoluminal visualization of the small bowel [ 1 ]. The clinical utility of the procedure is undisputed [ 2 ] [ 3 ] [ 4 ], and for most patients, swallowing the capsule (11 × 33 mm in size) does not pose any problems. However, use of the capsule in small children has not yet been reported. A 3-year-old boy was admitted to our hospital with chronic iron-deficiency anemia and tarry stools. The hemoglobin level had ranged from 3.4 to 10.3 over a 2-year period, despite continuous iron replacement therapy. Upper and lower endoscopy, computed tomography of the abdomen, Meckel scintigraphy, and a small-bowel follow-through had all been unremarkable. Capsule endoscopy was carried out with the patient under general anesthesia. The capsule was grasped in a polypectomy snare through the endoscope and pushed through the upper esophageal sphincter. The capsule was placed in the duodenal bulb, to avoid the risk of gastric retention of a capsule this size. After 54min (approximately 30min after release), a large polypoid tumor without ongoing bleeding was clearly visualized (Figure [ 1 ]). The rest of the small bowel was normal, with passage of the cecum after a total time of 4 min 50 s. Figure 1 Capsule image showing a polypoid lesion in the jejunum, causing partial obstruction of the lumen. Based on the capsule endoscopy finding, a minilaparotomy was performed, and a tumor 17 × 15 mm in size was found and resected in the suspected part of the jejunum, 100 cm from the ligament of Treitz (Figure [ 2 ]). Histology showed that the lesion consisted of hamartomatous tissue, without no sign of malignancy. The postoperative course was uneventful, with no recurrence of anemia. Figure 2 The resected specimen, a 17 × 15 mm hamartomatous polyp. This case illustrates the feasibility of capsule endoscopy even in small children, using an endoscope to insert the capsule. It also shows the low sensitivity of small-bowel follow-through studies in detecting small to moderate-sized tumors in the small bowel.