Video capsule endoscopy in children shows diagnostic yield for Crohn's disease but requires endoscopic placement

IntroductionVideo capsule endoscopy (VCE) enables direct, radiation-free visualization of the small bowel mucosa and is endorsed by pediatric guidelines as a key tool in the evaluation of Crohn's disease (CD). Despite this, VCE remains underused in routine pediatric practice, and its real-world clinical impact is insufficiently characterized. We aimed to assess the diagnostic yield, safety, and management consequences of pediatric VCE in a tertiary center and to compare its findings with cross-sectional imaging and biomarkers.MethodsWe conducted a retrospective, single-center study of VCE procedures in children younger than 18 years performed between 2018 and 2024. Demographic, clinical, imaging, and laboratory data were reviewed to characterize indications, safety, and clinical yield.ResultsSeventy-six VCE examinations were performed in 60 children (mean age 14.8 years; 41% female). Endoscopic placement was required in 19 patients (25%). Dissolvable patency capsule testing to evaluate non-retention of the real VCE was performed in 22/80 (27.5%) planned VCEs, with four failures that abrogated further application of VCE. The main indication for VCE was suspected or established CD (57 VCEs in 45 children); other indications included polyposis syndromes, eosinophilic gastrointestinal disease, iron deficiency anemia, and gastrointestinal bleeding. In the CD subgroup, VCE supported a new diagnosis in 13 of 28 cases (46%) and prompted disease reclassification in 12 of 29 cases (41%). Small bowel inflammation was noted in 35 of 42 VCEs (83%) in new or known patients with CD [Lewis score (LS) > 135], with a median LS of 563. VCE findings led to the initiation or escalation of CD treatment in 22 of 42 patients (52%). One capsule retention occurred, revealing a previously unsuspected severe stricturing (B2) phenotype and leading to a planned, nonurgent intestinal resection. Among the 46 children who underwent both VCE and cross-sectional imaging, concordance between VCE and MRE/IUS was modest (κ = 0.07, 95% CI −0.19 to 0.34), underscoring the complementary value of VCE.ConclusionVCE is a safe and well-tolerated modality for evaluating pediatric small bowel disease, particularly CD, and frequently reveals clinically relevant inflammation missed by conventional imaging. These findings support its broader integration into pediatric practice.