Videocapsule Endoscopy in Inflammatory Bowel Disease

Abstract

Traditionally, colonoscopy and biopsies along with radiological studies have served as the imaging “gold standards” for the evaluation of patients with suspected or known inflammatory bowel disease (IBD), both in adult and pediatric cases. Imaging is essential at the initial evaluation to establish the diagnosis and to assess the location, extent, and severity of disease. In pediatric onset cases, we reported that esophagogastroduodenoscopy (EGD) with biopsies were of clinical value in order to ascertain the presence of findings suggestive of Crohn disease in the upper gastrointestinal tract. This has been incorporated in the diagnostic guidelines of the IBD Working Group of the European Society for Pediatric Gastroenterology Hepatology and Nutrition. Other imaging techniques employed in IBD are extensively discussed elsewhere in this book. These include trans-abdominal (US), with or without contrast enhancement (CEUS), endoscopic ultrasound (EUS), enterography by computed tomography (CTE) or magnetic resonance imaging (MRE), as well as nuclear scans and positron emission tomography. Despite these techniques, complete assessment of the small bowel has remained a challenge. Whereas push enteroscopy surpasses EGD, it only affords visualization of the proximal jejunum and is relatively invasive in young children. Intra-operative enteroscopy is even more invasive, necessitating a laparotomy or laparoscopy. Double-balloon enteroscopy (DBE) is a relatively new technique that can achieve diagnostic, as well as therapeutic, enteroscopy for the entire bowel, without requiring surgery. However, this procedure requires a long period of manipulation, and relatively little experience in pediatric patients has been reported to date. Thus, the small bowel has been a relatively inaccessible “black box” for pediatric endoscopy specialists. That all changed rather dramatically with the development of videocapsule endoscopy (CE). This innovative technique has revolutionized enteroscopy, providing for the first time a noninvasive method for the complete endoscopic evaluation of the small bowel mucosa. The extremely short focal length of the lens permits incredibly precise imaging of the intestinal mucosa as the capsule transits along the lumen, without requiring insufflation of air. The astounding resolution of the lens yields extraordinarily detailed, high-quality images of the mucosa and offers the ability to visualize normal villi, easily identifying focal areas of villous edema or atrophy. A meta-analysis has shown that CE is better able to identify small bowel lesions consistent with Crohn disease compared to traditional radiological methods. The goals of this review are to provide an update on the clinical utility of CE for IBD in the pediatric age group, as well as information on the practical applications of CE in children.