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236 DIAGNOSTIC ACCURACY OF CAPSULE ENDOSCOPY IN PEDIATRIC PATIENTS WITH POLYPOSIS SYNDROMES F Costea, MH Dirks, EG Seidman BACKGROUND: The surveillance of pre-malignant polyps in the small bowel for hereditary polyposis syndromes has several limitations. Capsule endoscopy (CE) is a safe, effective method to explore the entire small bowel non-invasively.
Divisions of Gastroenterology, Montreal Children's and Ste Justine Hospitals, McGill & University of Montreal, Montreal, Quebec
AIM: To assess the diagnostic accuracy of CE for detecting small bowel polyps in pediatric patients with gastrointestinal hereditary polyposis syndromes compared to standard investigations [small bowel barium radiography (SBR) upper endoscopy (UE), and ileo-colonoscopy (IC)].
PATIENTS AND METHODS: We prospectively studied consecutive cases referred for polyposis syndromes over a 3 yr period (2003-2006). CE results were compared to findings on SBR (gastric & small bowel), IC (term. ileal) & UE (gastro-duodenal) by 2 expert observers unaware of the comparative study results. The data are expressed as overall accuracy, defined as the number of correct predictions [true positives (TP) and true negatives (TN)] divided by the total number of predictions made (correct and incorrect), expressed as a %.
RESULTS: Among the 176 pediatric patients that underwent CE in our 2 centres over this period, 12 (15.8%; 12-17 yr; 10M/2F) were referred for intestinal polyposis: 8 a diagnosis of Peutz-Jegher syndrome (PJS) established by colonoscopy (7) or UE (1) + histology; 2 each were referred for a history of Familial Adenomatous Polyposis (FAP) or colonic juvenile polyposis confirmed by IC & histology. The diagnostic accuracy of UE for gastro-duodenal disease was 100% (9 TP, 3 TN), as was that of IC for terminal ileal disease (1 TP, 11 TN). In contrast, the diagnostic accuracy of SBR was only 41.7% (2 TP, 3 TN; 6 false negatives & 1 false positive). The diagnostic accuracy of CE for gastric or small bowel pathology was found to be 100% (10 TP, 2 TN). Two patients were observed to have typical findings of Crohn's disease of the small bowel by CE, whereas the SBR was falsely negative in both. Finally, the number of polyps seen by CE in the small bowel of the 7 confirmed cases of small bowel polyposis was significantly higher than that detected with SBR (p < 0.01).
CONCLUSIONS: CE is a highly accurate screening method for small bowel polyps in pediatric patients, affording greater precision, avoiding radiation, and is preferred by patients over standard tests. CE should replace SBR for 1st line screening in polyposis syndromes in pediatric patients, as has been suggested for adult patients. Polyps detected may be resected by push or push & pull (double balloon) enteroscopy, depending upon their localization.
Disclaimer: Dr Seidman is a member of the Advisory Board for Given Imaging Inc