Capsule endoscopy in pediatrics: A growing experience

Capsule endoscopy (CE) usage and research in pediatrics is in its infancy but is growing. The possibility of avoiding ionizing radiation, deep sedation, and general anesthesia makes CE an appealing tool for diagnosis and disease state monitoring in luminal pediatric gastrointestinal disorders. As such, clinical use is expanding, but research has lagged behind, focusing on inflammatory bowel diseases (IBD) and polyposis syndromes. Food and Drug Administration approval in 2009 for children 2 years of age and older has resulted from the broader application of CE. In turn, this acceptability has fostered use in infants as young as 8 months (and 7.9 kg in weight). With these age differences (within the pediatric population and in comparison with adults), the indications have changed, with continued emphasis on not only patients with IBD but also in younger children who have a lower incidence of IBD, with more concern regarding occult bleeding and additional small bowel disorders, including graft-vs-host disease, Henoch-Schönlein purpura, cystic fibrosis, and lymphangiectasia. The ability to swallow or place the capsule remains a concern, but retention parallels adult indications rather than age. To date, esophageal capsules have been used primarily for the evaluation of varices, although the colon capsule has been used to further understand IBD in both the small bowel and the large bowel. With this varied and expanded use has come comparisons with other diagnostic modalities, attempts to integrate CE with these modalities into effective and cost-effective clinically assessed algorithms, and a plea for further research and the funding to make that possible.