One thousand small-bowel biopsies in children - A single-port versus a double-port capsule

Background: Small-bowel biopsy is a well-established technique in the evalu ation of children with intestinal malabsorption, e.g. coeliac disease. The biopsy is performed endoscopically or with a peroral capsule instrument. Th e aim of the present retrospective study was to compare the single-port Wat son capsule with the double-port Storz capsule with regard to procedure and fluoroscopy time, complications and failure rate. Methods: All 1,078 peror al small-bowel biopsies performed at our department during 1989-99 were stu died. In 387 of these, the Watson capsule was used and in the remaining 691 the Storz capsule. Median age of the children was 2.5 years. About one-thi rd of the children were premedicated with the prokinetic drug cisapride and as sedatives alimemazine or diazepam orally. Two-thirds of the children we re given metoclopramide along with midazolam intravenously. The biopsies we re performed under intermittent fluoroscopy. Results: The median biopsy pro cedure time was significantly shorter with the Storz capsule (7 min) compar ed to the Watson capsule (10 min) (P < 0.05). The median fluoroscopy time w as 5 sec with the Storz capsule and 8 sec with the Watson capsule (P < 0.01 ). The failure rate did not differ significantly between the two capsule ty pes: 10.3% (Watson) and 7.7% (Storz). One potential but no serious complica tion occurred. Conclusions: Providing that effective sedation is available. small-bowel biopsy with a peroral capsule, and the Storz double-port multi biopsy capsule in particular, is a safe and fast method exposing the child to a minimal radiation dose.