A major consequence of portal hypertension (PH) is variceal hemorrhage (VH). The feasibility, safety, and clinical impact of esophageal capsule endoscopy (ECE) in pediatric and young adult patients with known or suspected PH were investigated.
ECE was administered to children and young adults with PH at Boston Children’s Hospital for variceal screening or monitoring. Retrospective evaluation of patient histories, ECE results, and clinical outcomes was performed. In 98 individuals (57.1% male patients). 149 ECE tests were done utilizing three ECE devices for variceal screening (66.5%) or surveillance (33.5%). The investigations were interpreted by three readers (88.3%, 10.3%, and 1.4%, respectively). The average age was 16 years (IQR 13.7–18.5). One hundred and three ECE trials included participants older than 18 (69.1%). Fifteen patients (29 ECE studies) had a history of gastrointestinal (GI) bleeding (GIB), with 5 in the foregoing 12 months.
Varices were seen in 62 ECE studies (44.9%): 59 esophageal (40 small, 19 medium/large), 17 gastric, and 6 duodenal. Portal gastropathy (25, 18.1%), esophagitis (20, 14.5%), ulcers (5, 3.6%), erosions (31, 22.5%), heterotopic tissue (13, 9.4%), blood flecks (23, 16.7%), and mucosal scars (17, 12.3%) were also discovered. There were two brief capsule retentions and no serious adverse effects.
In 11 (7 variceal bandings) cases, ECE resulted in a follow-up EGD, and in 12 cases (4 proton-pump inhibitors, 7 nonselective beta-blocker, 2 other), medication was started. Within 12 months after ECE, four patients developed GIB. For screening and monitoring of esophageal varices in children and young adults, ECE is a viable alternative to EGD.
Reference:journals.lww.com/jpgn/Fulltext/2019/12000/Esophageal_Capsule_Endoscopy_in_Children_and_Young.5.aspx
