DDW: Camera in a Pill Feasible for Small Children

WASHINGTON, May 22 -- Babies as young as 18 months -- even if they're malnourished and small -- can have intestinal disorders diagnosed with a wireless camera in a pill, a European researcher said here.

In a series of 58 patients, ages 18 months to eight years, a diagnosis could be made in all cases using wireless capsule endoscopy, according to Annette Fritscher-Ravens, M.D., of University Hospital Eppendorf in Hamburg. She was at Homerton University Hospital in London during the study.

Patients were divided into two groups, depending on their ability to swallow the fingertip-sized capsule, Dr. Fritscher-Ravens said during Digestive Disease Week session.

Even in children unable to swallow -- from 18 months to about four years -- use of "introducer" technology allowed the researchers to make a diagnosis in all cases, she said.

Using a small rag doll to illustrate the size of some of the patients in the study, Dr. Fritscher-Ravens said, "We could prove that with these children it is possible examine major disorders of the gut that it is not possible to examine by other means than surgery."

The technology is not currently used in small children, she said, because of fears that the camera capsule might lodge in the gut. Indeed, in the U.S., the technology is only approved for children older than 10.

But Dr. Fritscher-Ravens said the camera passed through the gut in all cases during their continuing nine-center study, which is intended to enroll 100 patients.

One key finding of the study, she said, is that diagnoses vary depending on age. In children between four and eight, about half had Crohn's disease and the remainder had other forms of inflammatory bowel disease.

But in younger children, the major diagnoses were gastrointestinal bleeding and protein loss, both important because of their effects on development, she said. "A diagnosis of bleeding in these children is majorly important," she said.

But without the use of the pill camera, she said, surgery would have been needed to make the diagnosis.

She cited one case -- a five year-old boy with major GI bleeding -- in which the capsule endoscopy revealed what looked like an aspirin ulcer. Consultation with the parents revealed the boy had been given regular ibuprofen, she said.

One message for clinicians hoping to use the technology, she said, is that not all "introducer" devices are equal.

The researchers found that one device -- the Roth net -- caused trauma to the pharynx and esophagus about half the time. The Advance introducer, on the other hand, did not cause any difficulties, she said.

"We will see continuing miniaturization of this technology," commented Gregory Ginsberg, M.D., of the University of Pennsylvania, who moderated the press conference at which Dr. Fritscher-Ravens discussed her work.

"As miniaturization progresses, it will be more acceptable for ingestion in children," he said in an interview.

On the other had, he said, it's not clear that manufacturers will devote the resources to develop technology to serve what is a "fairly small indication" or to conduct the appropriate clinical trials.