Enteroscopy in children

Abstract

Introduction: Device-assisted enteroscopy is a new endoscopic technique for the evaluation of small bowel in adults and children. Data in pediatric population are limited. This review aims to identify diagnostic and therapeutic benefits of enteroscopy in children.

Methods: We have analysed paediatric literature on device-assisted enteroscopy focusing on indications, technical aspects and complications, with attention given to adult publications that may be applicable to the paediatric population.

Results: Obscure gastrointestinal bleeding, Crohn's disease and small bowel polyps are the main indications of enteroscopy in children. Device-assisted enteroscopy has high diagnostic yield for the main paediatric indications, but MR-enterography and capsule endoscopy should be used beforehand in diagnostic work-up to better identify candidates for enteroscopy and to improve its diagnostic and therapeutic yield. Major complications are rare and mostly related to therapeutic procedures.

Conclusion: Despite limited data in the paediatric population, device-assisted enteroscopy represents a useful and safe endoscopic technique in children. Its use, combined with MR-enterography and capsule endoscopy, allows identification and treatment of many of the small bowel paediatric diseases with a low risk of complications.

Keywords: Crohn’s disease; Enteroscopy; obscure gastrointestinal bleeding; polyps; small bowel disorders.

Figure 1.

Enteroscopic findings of the main small bowel diseases. Bleeding ulcer (a), pedunculated polyp (b) treated with polypectomy (c), angiodysplasia treated with clip placement (d and e).

Figure 2.

Proposed algorithm for children with obscure gastrointestinal bleeding. In children with negative upper endoscopy and colonoscopy, MR-enterography and/or Meckel scan are recommended. If imaging is positive, detected lesions should be treated with enteroscopy or surgery, while in presence of unspecific or negative imaging findings, CE should be done. If CE is positive, specific management should be carried out. If CE is negative, the patient should have a clinical follow-up and in case of recurrence, CE-second look or BAE should be considered. GI: gastrointestinal; CE: capsule endoscopy; BAE: balloon-assisted enteroscopy.

Figure 3.

Proposed algorithm for children with suspected Crohn’s disease. BAE is recommended when conventional studies, including oesophagogastroduodenoscopy, ileocolonoscopy and imaging of SB and CE, have not been determined and histological diagnosis and/or therapeutic procedure would alter disease management (adapted from Di Nardo et al.). GI: gastrointestinal; SB: small bowel; CE: capsule endoscopy; BAE: balloon-assisted enteroscopy.