Salvatore Oliva1, Marco Pennazio2, Stanley A Cohen3, Marina Aloi1, Arrigo Barabino4, Cesare Hassan5, Andrea Pession6, Mario Lima7, Simone Frediani1, Giovanni Di Nardo8. 1. Department of Pediatrics, Paediatric Gastroenterology Unit, Sapienza - University of Rome, Rome, Italy. 2. Division of Gastroenterology 2, Department of Medicine, S. Giovanni AS University Teaching Hospital, Turin, Italy. 3. Children's Centre for Digestive Health Care, Atlanta, GA, United States. 4. Department of Pediatrics, Gastroenterology Unit, Institute G. Gaslini, Genova, Italy. 5. Digestive Endoscopy Unit, Catholic University, Rome, Italy. 6. Department of Pediatrics, Paediatric Gastroenterology and Nutrition Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. 7. Department of Paediatric Surgery, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. 8. Department of Pediatrics, Paediatric Gastroenterology Unit, Sapienza - University of Rome, Rome, Italy. Electronic address: giovanni.dinardo@uniroma1.it.
Abstract
BACKGROUND: This prospective single-centre study aims to evaluate a new diagnostic algorithm using capsule endoscopy, colon capsule endoscopy and single-balloon enteroscopy in the work-up of obscure gastrointestinal bleeding in children. METHODS: The usefulness of a new diagnostic algorithm was assessed comparing the clinically relevant findings revealed by each technique, and evaluating the clinical outcomes during the follow-up. RESULTS: A total of 22 paediatric patients were evaluated (14 male; mean age 12.5 years ± 3.9). Capsule endoscopies were positive in 14 (63.6%), suspicious in 5 (22.7%) and negative in 3 (13.6%). A second look with colon capsule identified new lesions in 2/3 (67%) of previous negative cases. Enteroscopies were able to reach the positive and suspicious findings in all but 2, in which an intraoperative enteroscopy was needed. This combined approach showed positive findings in 21/22 of cases with a diagnostic yield of 95%. Eighteen patients (82%) had a complete resolution after therapy. One patient resolved his symptoms spontaneously. Despite diagnosis, in three patients (13.6%) the gastrointestinal bleeding was not resolved after therapy. CONCLUSION: This algorithm achieves optimal levels of diagnostic yield (95%) and therapeutic outcome (82%). This approach deserves to be studied in a larger multicentre cohort of patients and for a longer follow-up period.
BACKGROUND: This prospective single-centre study aims to evaluate a new diagnostic algorithm using capsule endoscopy, colon capsule endoscopy and single-balloon enteroscopy in the work-up of obscure gastrointestinal bleeding in children. METHODS: The usefulness of a new diagnostic algorithm was assessed comparing the clinically relevant findings revealed by each technique, and evaluating the clinical outcomes during the follow-up. RESULTS: A total of 22 paediatric patients were evaluated (14 male; mean age 12.5 years ± 3.9). Capsule endoscopies were positive in 14 (63.6%), suspicious in 5 (22.7%) and negative in 3 (13.6%). A second look with colon capsule identified new lesions in 2/3 (67%) of previous negative cases. Enteroscopies were able to reach the positive and suspicious findings in all but 2, in which an intraoperative enteroscopy was needed. This combined approach showed positive findings in 21/22 of cases with a diagnostic yield of 95%. Eighteen patients (82%) had a complete resolution after therapy. One patient resolved his symptoms spontaneously. Despite diagnosis, in three patients (13.6%) the gastrointestinal bleeding was not resolved after therapy. CONCLUSION: This algorithm achieves optimal levels of diagnostic yield (95%) and therapeutic outcome (82%). This approach deserves to be studied in a larger multicentre cohort of patients and for a longer follow-up period.
Authors: Giovanni Di Nardo; Carlo Calabrese; Roberto Conti Nibali; Arianna De Matteis; Emanuele Casciani; Luigi Martemucci; Giuseppe Pagliaro; Nico Pagano Journal: United European Gastroenterol J Date: 2018-07-12 Impact factor: 4.623