DOI: 10.1097/01.mpg.0000173604.85012.f5

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PMID: 16131998

Issn Print: 0277-2116

Publication Date: 2005/09/01


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Endoscopic Placement of a Capsule Endoscope in a 5-Year-Old Child

Diego García-Compeán; Martha Urquidi

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Author Information: Regional Center for the Study of Digestive Diseases University Hospital Autonomous University of Nuevo León and the Digestive Functional Research Center Centro Medico San Francisco Monterrey, Nuevo Leon, Mexico,

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To the Editor: Capsule endoscopy is currently one of the most widely used procedures for detecting mucosal lesions in the small bowel in adults (1,2). The size of the capsule (26 × 11 mm) prevents it from being swallowed by small children; therefore, it has to be placed through endoscopy. Here, we describe an endoscopic technique we used to place a capsule endoscope in a 5-year-old boy with gastrointestinal bleeding. The patient weighed 17.5 kg and presented with hematochezia at our hospital. Colonoscopy showed actively bleeding vascular malformations in the sigmoid and ascending colon. Some of them were cauterized. We felt examination of the small bowel by means of capsule endoscopy was required to define the extent of disease and treatment.
Satisfactory general endotracheal anesthesia was established. An esophagogastroduodenoscope (EG-2901; Pentax Precision Inst. Corp. Orangeburg, NY) with an insertion tube of 9.8 mm and an accessory channel of 2.8 mm in diameter was used with a translucent ligation adaptor attached to the tip (Wilson Cook Medical, Winston Salem, NC). A net retrieval catheter of 2.5 cm diameter (Foreign Body Rothnet, US Endoscopy Group, Mentor, OH) was introduced through the accessory channel of the endoscope. The capsule endoscope was placed in the net, and it was then closed. The catheter was pulled back toward the endoscope, stabilizing the capsule at the base of the adaptor and forming a stable block (Fig. 1). With the patient in left lateral decubitus, the endoscope was introduced. Once in the stomach, the net catheter was pushed 2 cm from the adaptor to improve the endoscopic view. The pylorus was located, the capsule was introduced into the duodenum, and the endoscope was introduced until the adaptor was close to the pylorus. Then, the capsule was pushed as far as possible into the duodenum and was released in the third part of the duodenum (Fig. 2). After the procedure, 5 mg of metoclopramide was administered intravenously. The capsule arrived at the colon 2 hours, 55 minutes after being placed. Small bowel mucosa did not show bleeding lesions. Vascular malformations with minor active bleeding were observed in the right colon.
Since 2001, when capsule endoscopy was approved by the Food and Drug Administration, it has proven to have had a high diagnostic yield in patients with obscure gastrointestinal bleeding (3,4). In 2003, the first case reports and small series reporting its use in children and adolescents appeared (5-10). In children younger than 10 years, the capsule has generally been placed endoscopically. In some of the first reports, a polypectomy snare (5) or a net retrieval catheter (6) was used. Recently, a translucent ligation adaptor was used in combination with a net retrieval catheter to stabilize the capsule to the tip of the endoscope (10). Our technique, similar to the latter, was relatively easy to perform. The lateral visibility permitted by the translucent ligation adaptor facilitates the safe introduction of the endoscope. Once in the stomach, pushing the net catheter a few centimeters forward improved the endoscopic view and allowed accurate location of the pylorus. It is highly advisable to introduce the capsule first into the duodenal bulb and then push it with the endoscope toward the distal duodenum to avoid its migration back into the stomach (5,6). Administration of prokinetic agents may be necessary.
Because the reports published concerning the use of capsule endoscopy in small children are scarce, its safety in this pediatric population is still not clearly established (5,6,10). A careful clinical evaluation and perhaps a small bowel radiograph before the procedure may be useful to detect pyloric or intestinal stenosis.
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