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目的评价胶囊内镜检查在儿科应用的有效性和安全性。方法对2007年9月至2010年12月福建医科大学附属漳州市医院28例临床疑诊小肠疾病的患儿进行胶囊内镜检查。观察胶囊内镜通过胃的平均时间、通过小肠的平均时间、成功率和失败率、小肠病变检出率及患儿的耐受性和并发症。结果 28例患儿均成功吞服胶囊内镜并完整排出,检查过程患儿耐受良好。胶囊内镜通过胃的时间20～280min(中位数64min),通过小肠的时间93～380min(中位数255min),检出病变20例(20/28,71.43%)。结论对疑诊小肠疾病,胶囊内镜检查是的一种有效和安全的方法。     

胶囊内镜对儿童小肠疾病诊断价值研究

摘要：目的　评价胶囊内镜检查在儿科应用的有效性和安全性。方法　对2007年9月至2010年12月福建医科大学附属漳州市医院28例临床疑诊小肠疾病的患儿进行胶囊内镜检查。观察胶囊内镜通过胃的平均时间、通过小肠的平均时间、成功率和失败率、小肠病变检出率及患儿的耐受性和并发症。结果　28例患儿均成功吞服胶囊内镜并完整排出,检查过程患儿耐受良好。胶囊内镜通过胃的时间20～280 min（中位数64 min）,通过小肠的时间93～380 min（中位数255 min）,检出病变20例（20/28,71.43%）。结论　对疑诊小肠疾病,胶囊内镜检查是的一种有效和安全的方法。     

胶囊内镜在青少年患儿中的应用

目的评估胶囊内镜对疑似患有小肠疾病的儿童患者检查的安全性和有效性。方法2002年8月至2005年5月,连续选择我院15例疑似小肠疾病的儿童和青少年患儿(18岁以下)进行胶囊内镜检查。年龄3～18岁,其中5例患儿年龄小于10岁;体重17～83 kg;身高49～176 cm。检查适应证包括不明原因消化道出血(12例)和腹痛(3例)。本组患儿胶囊内镜检查前胃镜和大肠镜检查结果均阴性。检查结束后分别记录胶囊内镜的置入方法、胃内通过时间、小肠通过时间、胶囊平均排出体外时间、诊断结果和并发症发生的情况。结果除3例最年幼者外,所有患儿均能顺利吞服胶囊。该3例患儿最后经胃镜辅助顺利将胶囊送至胃内。检查期间无1例出现胶囊滞留等并发症。胶囊内镜平均检查时间为(464±40)min。15例中共5例至检查结束胶囊尚未到达回盲瓣。胶囊内镜平均胃内通过时间为(85±90)min,平均小肠通过时间为(283±106)min,平均排出时间为(34.3±21.8)h。胶囊内镜的病变检出率为80%。结论对于儿童患者,胶囊内镜检查(吞服或经胃镜送入)安全可行,其较高的病变检出率与成人患者相似。     

胶囊内镜在儿童克罗恩病中的诊断价值

目的探讨胶囊内镜在儿童小肠克罗恩病中的诊断价值及安全性。方法回顾性分析2003年1月至2010年4月经胶囊内镜检查的25例克罗恩病患儿临床资料,分析其临床表现、胶囊内镜检查完成情况、镜下特点及诊断情况。结果 25例克罗恩病患儿共行26次胶囊内镜检查,均顺利吞下胶囊内镜,其中21例在工作时间内到达回盲瓣,过瓣率80.8%(21/26);21例经胶囊内镜诊断克罗恩病,主要表现为阿弗他溃疡,环状或裂隙样溃疡。所有病例均无胶囊内镜梗阻发生。结论胶囊内镜在诊断儿童克罗恩病中安全,较其他影像学检查诊断率高,尤其是对累及小肠的克罗恩病,胶囊内镜下表现特异。     

儿童不明原因便血55例临床分析

目的探讨儿童不明原因便血的病因。方法回顾性分析55例不明原因便血患儿的临床资料,并根据病情选择性进行胃镜、结肠镜、双气囊小肠镜、胶囊内镜、腹部放射性核素99mTc扫描及小肠多层螺旋CT血管成像(CTA)检查,最终明确诊断。结果 55例患儿便血的病因依次为小肠肠管发育畸形、肠血管性疾病、炎症性肠病、嗜酸细胞性胃肠炎、十二指肠溃疡、肠结核、升结肠息肉等。结论儿童便血的病因复杂多样,应根据病史、便血色泽及性状、伴随症状等来选择相应的辅助检查,从而明确诊断。     

胶囊内镜在以便血为主诉的小肠疾病患儿中的应用价值

目的 评估胶囊内镜在以便血为主诉的小肠疾病患儿中的价值。方法 回顾性收集2015年5月至2019年1月复旦大学附属儿科医院收治的以便血为主诉且行胶囊内镜检查的93例患儿的临床资料及胶囊内镜检查结果,根据胶囊内镜检查结果（空肠及回肠段）分为阳性病变组（n=39）及阴性病变组（n=54）,对两组的临床资料及胶囊内镜下的病变特征进行分析。结果 阳性病变组和阴性病变组患儿的年龄、性别、胶囊内镜检查时间、胃通过时间及小肠通过时间比较差异均无统计学意义（P > 0.05）。阳性病变组患儿的血红蛋白水平低于阴性病变组（P < 0.05）。血红蛋白值与胶囊内镜下阳性病变率呈负相关（r=-0.342,P=0.001）。胶囊内镜下发现有阳性病变的病例中,诊断为梅克尔憩室的比例最高（41%,16/39）,其次为炎症性肠病（21%,8/39）。结论 胶囊内镜对下消化道出血患儿小肠疾病,特别是空肠及回肠段疾病的阳性检出具有一定价值。     

胶囊内镜在以便血为主诉的小肠疾病患儿中的应用价值

目的 评估胶囊内镜在以便血为主诉的小肠疾病患儿中的价值。方法 回顾性收集2015年5月至2019年1月复旦大学附属儿科医院收治的以便血为主诉且行胶囊内镜检查的93例患儿的临床资料及胶囊内镜检查结果,根据胶囊内镜检查结果（空肠及回肠段）分为阳性病变组（n=39）及阴性病变组（n=54）,对两组的临床资料及胶囊内镜下的病变特征进行分析。结果 阳性病变组和阴性病变组患儿的年龄、性别、胶囊内镜检查时间、胃通过时间及小肠通过时间比较差异均无统计学意义（P > 0.05）。阳性病变组患儿的血红蛋白水平低于阴性病变组（P < 0.05）。血红蛋白值与胶囊内镜下阳性病变率呈负相关（r=-0.342,P=0.001）。胶囊内镜下发现有阳性病变的病例中,诊断为梅克尔憩室的比例最高（41%,16/39）,其次为炎症性肠病（21%,8/39）。结论 胶囊内镜对下消化道出血患儿小肠疾病,特别是空肠及回肠段疾病的阳性检出具有一定价值。     

儿童隐源性多灶性溃疡性狭窄性小肠炎1例并文献复习

目的：报道1例儿童隐源性多灶性溃疡性狭窄性小肠炎（CMUSE）的临床特点,提高对该罕见病的认识。方法：总结1例儿童CMUSE的临床特点、实验室检查、影像学检查及内镜下表现、病理特征和诊疗经过。并行文献复习,总结CMUSE的临床表现及预后。 结果：男,9岁6个月,因“反复贫血伴黑便6年”就诊。患儿3岁多出现口唇苍白,以“缺铁性贫血”治疗效果欠佳,后相继出现反复柏油样便和腹痛,住院查炎症指标正常,胃镜和结肠镜检查未见异常,胶囊内镜示小肠多发环形狭窄伴溃疡,组织病理学未见特异性表现,诊断为CMUSE。予强的松龙和硫唑嘌呤口服,复查胶囊内镜,病变明显好转。目前随访8个月,患儿无复发。文献复习发现CMUSE好发于中青年,18~50岁占68.6%（35/51）。就诊前平均病程9.9年。CMUSE发病早期以腹痛（67.9%）、贫血（32.1%）和消化道出血（18.5%）为主要表现。胶囊内镜滞留率37.9%,再手术率29.7%。结论：不明原因的反复黑便、贫血伴发小肠溃疡和狭窄性病变时需考虑CMUSE。内镜检查的诊断价值较高。糖皮质激素治疗有效,但易复发,预后欠佳。     

胃镜结肠镜联合诊断儿童小肠淋巴管扩张症(附3例报告)

目的探讨胃镜-结肠镜联合对儿童小肠淋巴管扩张症(IL)的诊断价值。方法针对2010年1月至2012年6月3例经重庆医科大学附属儿童医院院胃镜-结肠镜联合检查、最终确诊IL病例,回顾性分析其临床表现、辅助检查、以及内镜下和组织病理特点。结果对3例疑诊IL患儿,安全、快速实施胃镜空肠输入段及结肠镜回肠末段检查,镜下所见并经病理组织活检证实小肠淋巴管扩张;结合其临床表现及其他辅助检查,顺利诊断儿童原发性小肠淋巴管(PIL)患者2例、继发性小肠淋巴管扩张症(SIL)1例。结论胃镜(必要时联合结肠镜)术、结合组织病理学检查,足以作为诊断儿童IL首选常规手段,具有安全、经济、高效的优点,尤其适用于小年龄儿童患者。     

双气囊小肠镜在消化道疾病中的应用

目的评价双气囊小肠镜在儿童消化道疾病中的应用价值。方法选择2006年12月-2010年12月广州市妇女儿童医疗中心收治的8例疑似小肠病变的患儿,其中以排黑便和(或)暗红色便为主要症状7例,以慢性腹泻、生长发育迟缓为主要症状1例。胃肠镜检查,单光子发射计算机断层成像术、胶囊胃镜、全消化道造影、腹腔动脉血管造影等检查,均为阴性。行双气囊小肠镜检查,7例患儿先经口再经肛门进镜检查,1例患儿经口进镜检查。结果分别经口及肛门进镜的7例患儿操作时间为120～150 min,经口进镜的1例患儿操作时间约为60 min。检出毛细血管扩张症2例,小肠淋巴管扩张症、嗜酸性肠病、胃窦溃疡各1例,未见明显病变3例,检出率约为62.5%。均未发生操作相关的严重不良反应和并发症。结论双气囊小肠镜可以弥补胃肠镜或胶囊内镜检查的不足,是一项安全有效的临床诊疗方法。     

Capsule endoscopy in the evaluation of gastrointestinal disease

PURPOSE OF REVIEW: The small bowel has been a technically difficult area to examine. Indirect modalities such as barium follow-through have the disadvantage of attendant radiation exposure. Capsule endoscopy, a novel wireless method of investigation of the small bowel, has acquired an important role in both adult and paediatric medicine. RECENT FINDINGS: The clinical utility of capsule endoscopy has rapidly expanded since its approval by the Food & Drug Administration in the USA in 2001. It has developed an established role in adults, in the investigation of obscure gastrointestinal bleeding, small bowel Crohn's disease, complications of coeliac disease and surveillance of polyposis syndromes. Despite a lag in its use in paediatrics, capsule endoscopy offers an accurate and effective means of investigating the small bowel in children. It has opened up new horizons and permitted a noninvasive approach to identifying occult lesions in the small bowel of children when conventional imaging has been unhelpful. SUMMARY: This review appraises the current literature to define the clinical indications and practical aspects of capsule endoscopy that are of interest to the paediatrician.     

Successful wireless capsule endoscopy for a 2.5-year-old child: obscure gastrointestinal bleeding from mixed, juvenile, capillary hemangioma-angiomatosis of the jejunum

The lesion responsible for obscure gastrointestinal bleeding in the pediatric population may not be determined with standard primary endoscopic methods. Wireless capsule endoscopy, now a first-line modality for evaluation of the small bowel in the adult population, is a tool that may be useful among children. We report a case of a 2.5-year-old girl who presented with melenic stools. Upper and lower endoscopy, Meckel scans, and mesenteric angiography yielded negative results. Wireless capsule endoscopy identified numerous abnormal, dilated, blood vessels in the proximal jejunum, with associated fresh blood. The patient underwent surgical exploration, with resection of the affected portion of the jejunum. Pathologically, the dilated blood vessels were consistent with mixed, juvenile, capillary hemangioma-angiomatosis of developmental or congenital origin. The patient fared well postoperatively, with no additional bleeding in 9 months of follow-up monitoring. This case report highlights the use of capsule endoscopy in the diagnosis and successful treatment of gastrointestinal bleeding in a young infant. This is the youngest reported patient treated with the use of wireless capsule endoscopy in the pediatric population.     

Role of wireless capsule endoscopy in reclassifying inflammatory bowel disease in children

ObjectiveTo evaluate the role of wireless capsule endoscopy in identifying small bowel lesions in pediatric patients with newly diagnosed colonic inflammatory bowel disease (IBD) type unclassified (IBDU), and to assess whether capsule endoscopy findings result in altered patient management.MethodsTen pediatric patients recently diagnosed with IBDU through standard investigations were recruited from the pediatric gastroenterology clinic at McMaster Children's Hospital to undergo capsule endoscopy using the Pillcam SB^TM (Given Imaging) capsule. Findings consistent with a diagnosis of Crohn's disease required the identification of at least three ulcerations.ResultsThree out of ten patients had newly identified findings on capsule endoscopy that met criteria for Crohn's disease. Three more patients had findings suspicious for Crohn's disease, but failed to meet the diagnostic criteria. Three additional patients had findings most consistent with ulcerative colitis, and one had possible gastritis with a normal intestine. Findings from capsule endoscopy allowed for changes in the medical management of three patients. In all ten cases, capsule endoscopy allowed for a better characterization of the type and extent of disease. No adverse outcomes occurred in the present cohort.ConclusionThis prospective study reveals that wireless capsule endoscopy is feasible, valuable, and non-invasive, offering the ability to potentially better characterize newly diagnosed pediatric IBDU cases by identifying lesions in the small bowel and reclassifying these as Crohn's disease.     

Clinical features of gastroduodenal Crohn's disease in adolescents

Ten cases of gastroduodenal inflammation were diagnosed by endoscopy among a series of 196 children with evidence of Crohn's disease involving other regions of the intestinal tract. Endoscopic and histologic confirmation of upper gastrointestinal tract involvement was performed only in those cases with suggestive symptoms. The mean age at presentation in the 10 cases with gastroduodenal inflammation was 14.6 +/- 1.9 (+/- SD) years, with involvement identified at the time of initial diagnosis of Crohn's disease in five of the 10. Eight of 10 cases occurred in boys. The major presenting symptoms were weight loss in five cases, epigastric pain in three, and recurrent vomiting in two. Hematemesis and melena occurred in only one of the 10 cases. Endoscopic and histological evidence of mucosal inflammation was seen in all 10 cases. Three of 10 cases had noncaseating granuloma present in biopsies of the stomach or duodenum. Two cases also had endoscopic and histological evidence of esophageal involvement. All cases were initially treated with oral corticosteroids, and in each instance a good clinical response was noted. Sucralfate (n = 1), 6-mercaptopurine (n = 1), and H2 receptor antagonists (n = 3) were used as adjunct therapy. After follow-up for 2.7 years (range, 0.5-5.5 years), none of the 10 cases required surgical intervention. Therefore, at least in the short-term, the outlook for adolescents with gastroduodenal Crohn's disease appears to be good and their medical management need not differ from those patients with Crohn's disease involving only more distal portions of the small intestine.     

Use of wireless capsule endoscopy in the management of severe Henoch-Schonlein purpura

Henoch-Schonlein purpura is a multisystem vasculitis that primarily affects children. Characteristic symptoms include purpura of the lower extremities and buttocks, abdominal pain, arthralgias, and hematuria. Gastrointestinal bleeding occurs in approximately 50% of children and, although often self-limiting, can be significant. Wireless capsule endoscopy has been found to be safe and effective for children over 10 years of age. It is now the preferred imaging modality for evaluating gastrointestinal bleeding from the small intestine. Here we report an unusual case of chronic Henoch-Schonlein purpura vasculitis, primarily affecting the gastrointestinal tract, in which wireless capsule endoscopy was helpful in evaluating and directing treatment options.     

Clinical application of wireless capsule endoscopy in pediatric patients for suspected small bowel diseases

Capsule endoscopy (CE) has been demonstrated to be safe and well tolerated in adults with suspicion of small intestinal diseases with negative results of gastroscopy and colonoscopy. However, its value in pediatric patients has not yet been well studied. This study aimed to evaluate the results and safety of CE in pediatric patients with suspicion of small bowel disorders. There were 16 consecutive children and adolescents (12 boys, 4 girls) and 15 adults (9 men, 6 women) referred to us for suspected small bowel diseases from August 2002 to September 2005. Among the pediatrics, six patients were less than 10 years old. Technique for capsule placement, gastric transit time, small bowel transit time, excretion time of capsule endoscopy, capsule findings, and complications were recorded. All 16 pediatric patients described that the capsule was easy to swallow except for three children. Finally we delivered the capsule under gastroscopy with overtube for these three children. No capsule retention occurred during our study. Median recording time was 7 h 44 min (range 6 h 51 min–9 h 11 min). Median gastric transit time was 83.5 min (range 4–296 min). Median small bowel transit time was 270 min (range 142–484 min).Median excretion time of capsule was 33.9 h (range 12–96 h). There was no significant difference in excretion time of capsule, gastric transit time and small bowel transit time between pediatric patients and adult patients (P > 0.05). CE was positive in 12 patients, including Crohn’s disease (4), hemangioma (2), angiodysplasia (2), Meckel diverticulum (1), polyp (1), aphthous ulcer in ascending colon (1), and cobblestone appearance of ileal mucosa. CE has been performed safely in a small series of pediatric patients after ingestion or endoscopic placement of the capsule. The high yield of abnormal findings was comparable to those of adult patients. Supported by Shanghai Leading Academic Discipline Project (Project number: Y0205).