Capsule Endoscopy in Inflammatory Bowel Disease (IBD) in Children

There is growing concern with recurrent radiation exposure particularly from routine
radiologic modalities in children, this is especially relevant in pediatric Crohn's Disease
in so far as CT entercolysis abdomen and small bowel series are often seen as complementary.
Although small bowel series is accepted as a routine diagnostic modality in pediatric IBD if
fluoroscopy time is kept to a minimum, its limitations are well defined and are especially
relevant in the early stages of IBD wherein fistulising, stricturing disease is less common.
Magnetic resonance enterography (MRE) has a diagnostic effectiveness comparable to other
radiological modalities for evaluation of adult patients with CD, but without radiation
exposure. However it is limited by expense, the availability of the requisite equipment and
software, need for sedation in pediatric population, limited expertise in accurate
interpretation especially in early lesions such as are more common in pediatric IBD, and
overall insensitivity to early mucosal lesions including vascular abnormalities.

Alternative modalities for small bowel imaging are being studied and include the routine use
of wireless-video capsule endoscopy (WCE) which allows visualization of the small-bowel
mucosal lesions in Crohn's disease. Because the risk for capsule retention in suspected or
established Crohn's disease is significantly increased; in some series up to 13%; pre WCE
small bowel imaging or patency capsule has become standard of care.

The main indications for WCE in Crohn's disease are to establish the diagnosis, to assess
disease prognosis, disease activity, and mucosal healing post therapy, and to define the
extent and severity of disease A small, prospective study of 27 patients suspected to have
Crohn's disease, revealed a sensitivity of 93% and specificity of 84% for the WCE examination
compared to surgical and enteroscopic tissue samples, and demonstrated a significant change
in their management Another prospective randomized blinded study adults (N = 21) reported the
sensitivity and specificity of CD in terminal ileum were 100% and 91% by WCE. Jensen
suggested WCE as first line modality for detection of small bowel CD beyond the reach of
colonoscopy. In adults with known CD, Karoui et al evaluated WCE in a prospective study (N =
20) comparing it to radiological techniques and concluded that WCE is more accurate in
detection of small bowel lesions in CD.

Inclusion Criteria:

- Patients aged 4 to 17.99 years at time of investigation

- IBD/CD and IBD/IC diagnosed based on standard clinical - histologic criteria

- Patient is scheduled to have MRE as standard of care for evaluation of disease
severity/ complication.

- Signed permission/assent/consent

Exclusion Criteria:

- IBD diagnosis not established

- Recent intestinal tract surgery / resection involving small bowel

- Use of NSAIDs 4 weeks prior to the Capsule endoscopy study.

- Patients are on prokinetic medication.

- Swallowing disorders, esophageal stricture or patients unable to swallow the capsule.

- Presence of gastrointestinal obstruction or ileus.

- Patient with implanted electro-medical device or pacemakers.