Role of capsule endoscopy in suspected celiac disease: A European multi-centre study.
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Luján-Sanchis Marisol, Pérez-Cuadrado-Robles Enrique, García-Lledó Javier, Juanmartiñena Fernández José-Francisco, Elli Luca, Jiménez-García Victoria-Alejandra, Egea-Valenzuela Juan, Valle-Muñoz Julio, Carretero-Ribón Cristina, Fernández-Urién-Sainz Ignacio, López-Higueras Antonio, Alonso-Lázaro Noelia, Sanjuan-Acosta Mileidis, Sánchez-Ceballos Francisco, Rosa Bruno, González-Vázquez Santiago, Branchi Federica, Ruano-Díaz Lucía, Prieto-de-Frías César, Pons-Beltrán Vicente, Borque-Barrera Pilar, González-Suárez Begoña, Xavier Sofía, Argüelles-Arias Federico, Herrerías-Gutiérrez Juan-Manuel, Pérez-Cuadrado-Martínez Enrique, Sempere-García-Argüelles Javier
Аннотация
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.