First successful antegrade single-balloon enteroscopy in a 3-year-old with occult GI bleeding

BackgroundBalloon enteroscopy is an emerging technique to allow access to the small intestine for both diagnostic and therapeutic purposes. To date, there have been few published data documenting the safety and efficacy of balloon enteroscopy in small children.ObjectiveTo describe our experience with single-balloon enteroscopy (SBE) in a 37-month-old toddler with occult GI bleeding.DesignA single case report.SettingA free-standing, academic children's hospital in Denver, Colorado.PatientThe patient was a 37-month-old, 13.5-kg toddler with persistent heme-positive stools, severe microcytic anemia, and hypoalbuminemia. Previous workup was significant for eosinophilic inflammation in the antrum and a video capsule study showing erythematous lesions in the small bowel.InterventionAn antegrade SBE was performed with the child under general endotracheal anesthesia, with biopsy specimens obtained from identified lesions in the jejunum and ileum.Main Outcome MeasurementsComplications and successful treatment of symptoms were the primary endpoints.ResultsThe procedure was performed successfully in 85 minutes, passing an estimated 200 cm beyond the pylorus, without complications. Identification of the lesions as consistent with eosinophilic enteropathy led to successful treatment with an elimination diet and corticosteroids.LimitationsThe primary limitation of this study is that it is a single case report. Therefore, it is difficult to make a generalized statement regarding the safety and efficacy of balloon enteroscopy in toddlers of this size.ConclusionsAntegrade SBE can be a well-tolerated and effective procedure to evaluate occult GI bleeding in children as young as 3 years of age. Further study is needed to better establish safety parameters for balloon enteroscopy in small pediatric patients.