The diagnostic value of capsule endoscopy in children with intestinal lymphangiectasia.

BACKGROUND Intestinal lymphangiectasia is an unusual cause of protein-losing enteropathy due to either congenital malformation or the obstruction of the intestinal lymphatics. However, few reports have investigated the use of video capsule endoscopy in children with intestinal lymphangiectasia. This study was performed to evaluate the diagnostic value of video capsule endoscopy for paediatric intestinal lymphangiectasia. METHODS In this retrospective study, we included all patients who underwent video capsule endoscopy between January 2014 and July 2020. Clinical information and video capsule endoscopy data were analysed. RESULTS Twelve children, 7 males and 5 females, with an age of disease onset of 4.5 (range: 3.2-9.3) years, and a disease duration of 12.0 (range: 1.3-30.0) months were enrolled. The most common symptoms were hypoproteinaemia (10, 83.3%), diarrhoea (7, 58.3%), oedema (6, 50.0%), and abdominal pain (3, 25.0%). Eight patients had low lymphocyte counts, whereas 10 had reduced serum albumin levels (23.2±5.8 g/L). Video capsule endoscopy revealed an overall white snowy appearance due to the presence of whitish, swollen villi in all patients. Regarding the macroscopic lesions of lymphangiectasia, 7 cases involved the entire small bowel from the duodenum to the ileocecal valve, while 5 cases involved part of the small bowel. All patients were treated with medium-chain triglyceride diets, and albumin infusions were administered for 10 patients; sirolimus treatment was administered to 3 patients. At the last follow-up, 5 patients still had hypoalbuminemia, and one patient had died of intestinal lymphoma. CONCLUSION Video capsule endoscopy is useful for the diagnosis of intestinal lymphangiectasia and should be applied as a valuable and less invasive examination to confirm or establish a diagnosis.