Luján-Sanchis M, Pérez-Cuadrado-Robles E, García-Lledó J, Juanmartiñena Fernández JF, Elli L, Jiménez-García VA, Egea-Valenzuela J, Valle-Muñoz J, Carretero-Ribón C, Fernández-Urién-Sainz I, López-Higueras A, Alonso-Lázaro N, Sanjuan-Acosta M, Sánchez-Ceballos F, Rosa B, González-Vázquez S, Branchi F, Ruano-Díaz L, Prieto-de-Frías C, Pons-Beltrán V, Borque-Barrera P, González-Suárez B, Xavier S, Argüelles-Arias F, Herrerías-Gutiérrez JM, Pérez-Cuadrado-Martínez E, Sempere-García-Argüelles J. Role of capsule endoscopy in suspected celiac disease: A European multi-centre study.
World J Gastroenterol 2017;
23:703-711. [PMID:
28216978 PMCID:
PMC5292345 DOI:
10.3748/wjg.v23.i4.703]
[Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 12/08/2016] [Accepted: 01/04/2017] [Indexed: 02/06/2023] Open
Abstract
AIM
To analyze the diagnostic yield (DY), therapeutic impact (TI) and safety of capsule endoscopy (CE).
METHODS
This is a multi-centre, observational, analytical, retrospective study. A total of 163 patients with suspicion of celiac disease (CD) (mean age = 46.4 ± 17.3 years, 68.1% women) who underwent CE from 2003 to 2015 were included. Patients were divided into four groups: seronegative CD with atrophy (Group-I, n = 19), seropositive CD without atrophy (Group-II, n = 39), contraindication to gastroscopy (Group-III, n = 6), seronegative CD without atrophy, but with a compatible context (Group-IV, n = 99). DY, TI and the safety of CE were analysed.
RESULTS
The overall DY was 54% and the final diagnosis was villous atrophy (n = 65, 39.9%), complicated CD (n = 12, 7.4%) and other enteropathies (n = 11, 6.8%; 8 Crohn's). DY for groups I to IV was 73.7%, 69.2%, 50% and 44.4%, respectively. Atrophy was located in duodenum in 24 cases (36.9%), diffuse in 19 (29.2%), jejunal in 11 (16.9%), and patchy in 10 cases (15.4%). Factors associated with a greater DY were positive serology (68.3% vs 49.2%, P = 0.034) and older age (P = 0.008). On the other hand, neither sex nor clinical presentation, family background, positive histology or HLA status were associated with DY. CE results changed the therapeutic approach in 71.8% of the cases. Atrophy was associated with a greater TI (92.3% vs 45.3%, P < 0.001) and 81.9% of the patients responded to diet. There was one case of capsule retention (0.6%). Agreement between CE findings and subsequent histology was 100% for diagnosing normal/other conditions, 70% for suspected CD and 50% for complicated CD.
CONCLUSION
CE has a high DY in cases of suspicion of CD and it leads to changes in the clinical course of the disease. CE is safe procedure with a high degree of concordance with histology and it helps in the differential diagnosis of CD.
Collapse