ABSTRACT
OBJECTIVES: To compare the diagnostic yield, sensitivity, and specificity of video capsule endoscopy (VCE) with double balloon enteroscopy (DBE), including comparison with histological findings as well as degree of concordance of the studies. METHODS: Retrospective review of pediatric patients who had DBE following VCE at a single center from 2006 to 2013. VCEs were interpreted by 1 of 4 pediatric gastroenterologists and DBEs were performed by a single endoscopist. RESULTS: Thirty-six patients ranging from 5 to 20 years had DBE following VCE. There were positive findings in 32 (88.8%) of VCE and 21 (58.3%) of DBE. Significant histological findings were identified in 16 patients (44.4%). When comparing VCE with DBE findings, VCE had a sensitivity of 95% and specificity of 20%. Overall concordance between VCE and DBE findings was weak with calculated kappa index of 0.1702; however, this varied widely by indication. VCE had sensitivity 100% and specificity 20% for detecting histologically significant lesions. DBE had sensitivity of 87% and specificity of 65%. CONCLUSIONS: This is the first pediatric study to evaluate diagnostic accuracy and concordance of VCE and DBE and to compare both to histological findings. Our study supports the high diagnostic utility of both the studies. VCE is highly sensitive with an excellent negative predictive value both for DBE findings and for histological findings; however, the utility of VCE is limited by low specificity. Sensitivity and specificity of DBE for detecting histologically significant findings were good. Overall agreement between VCE and DBE is low but varies by indication for the study. These results support the use of VCE and DBE as complementary studies.
Subject(s)
Capsule Endoscopy/methods , Double-Balloon Enteroscopy/methods , Adolescent , Child , Child, Preschool , Female , Humans , Male , Predictive Value of Tests , Retrospective Studies , Sensitivity and Specificity , Young AdultABSTRACT
We report 2 children with Kawasaki disease, who developed pancreatitis and common bile duct abnormalities. After reviewing the literature, we conclude that Kawasaki disease may lead to such changes as a result of the underlying vasculitis characterizing this disease, or of direct inflammation of the biliary tree.
Subject(s)
Common Bile Duct Diseases/complications , Mucocutaneous Lymph Node Syndrome/complications , Pancreatitis/complications , Child , Child, Preschool , Common Bile Duct Diseases/diagnosis , Constriction, Pathologic/complications , Constriction, Pathologic/diagnosis , Coronary Artery Disease/complications , Humans , Male , Mucocutaneous Lymph Node Syndrome/diagnosis , Pancreatitis/diagnosisABSTRACT
Idiopathic fibrosing pancreatitis is a rare condition that affects children and adolescents. It can be the cause of recurrent abdominal pain and obstructive jaundice. There are 46 cases reported in the literature, including the first case reported by Comfort et al (Comfort MW, Gambill EE, Baggenstoss AH. Chronic Relapsing Pancreatitis. Gastroenterology 1946;6:239-285) in 1946. We report the case of a 3-year-old girl who presented with abdominal pain and obstructive jaundice. We performed a magnetic resonance cholangiopancreatography study as part of the workup of obstructive jaundice. We will review the literature on pediatric idiopathic fibrosing pancreatitis and highlight the use of endoscopic retrograde choledocho-pancreatography and magnetic resonance cholangiopancreatography in the investigation of this disease.
