Capsule endoscopy in adult celiac disease: A potential role in equivocal cases of celiac disease?
Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom. Gastrointestinal endoscopy
(Impact Factor: 5.37).
11/2012; 77(2). DOI: 10.1016/j.gie.2012.09.031
BACKGROUND: There have been limited studies evaluating capsule endoscopy (CE) in equivocal celiac disease (CD). OBJECTIVE: To determine the role CE may have in equivocal CD cases, compared with patients with biopsy-proven and serology-proven CD who have persisting symptoms. DESIGN: Prospective cohort study. SETTING: University hospital. PATIENTS: A total of 62 patients with equivocal CD and 69 patients with nonresponsive CD. INTERVENTION: CE. MAIN OUTCOME MEASUREMENTS: Diagnostic yield of CE in equivocal cases and accuracy of mucosal abnormality detection in patients with nonresponsive CD. RESULTS: Equivocal cases (n = 62) were divided into two subgroups: group A (antibody-negative villous atrophy, n = 32) and group B (Marsh 1-2 changes, n = 30). In group A, CE secured a diagnosis of CD or Crohn's disease in 28% (9/32), significantly higher than the diagnostic yield in group B (7%; P = .044). In patients with CD with persisting symptoms, significant CE findings were identified in 12% (8/69), including 2 cases of enteropathy-associated lymphoma, 4 type 1 refractory disease cases, 1 polypoidal mass histologically confirmed to be a fibroepithelial polyp, and 1 case of ulcerative jejunitis. This outcome was significantly lower than the diagnostic yield of CE in antibody-negative villous atrophy (P = .048). LIMITATIONS: Single center. CONCLUSION: There have been no previous reports systematically evaluating equivocal CD by using CE. The diagnostic yield of CE in patients with antibody-negative villous atrophy is better than that of CE in patients with CD with persisting symptoms. We advocate the use of CE in equivocal cases, particularly in patients with antibody-negative villous atrophy.
Available from: Antonio Tursi
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ABSTRACT: Video capsule endoscopy (VCE) has become the first choice in the evaluation of suspected small bowel bleeding [1–4]. The positive impact of VCE on clinical outcomes in patients with obscure gastrointestinal bleeding (OGIB) has been demonstrated in several studies [5–7]. VCE showed a better diagnostic yield in detecting mucosal lesions in patients with OGIB when compared with radiologic investigations such as small bowel follow-through (SBFT), small bowel enteroclysis (SBE), or cross-sectional imaging such as CT scans or MRI [2, 4, 8–10]. Device-assisted enteroscopy (DAE), which comprises single-balloon, double-balloon, and spiral enteroscopy, also enables inspection of the whole small bowel mucosa and permits the performance of therapeutic interventions . DAE is time-consuming, however; so VCE and DAE should be considered complementary procedures. The effect of VCE on diagnosis and outcome in patients with established Crohn’s disease (CD) and clinically suspected CD has been also demonstrated in several studies [11–15]. Recent studies have also shown that VCE is useful for screening and surveillance of patients with polyposis syndromes [16, 17]. Furthermore, the usefulness of VCE for patients with celiac disease or for patients with symptoms such as chronic diarrhea and chronic abdominal pain (when accompanied by inflammatory markers), and for less frequent small bowel diseases, has been increasingly demonstrated in recent publications [18–22].
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ABSTRACT: Video capsule endoscopy (VCE) is an established endoscopic modality that allows remote examination (without intubation) of almost the whole of the gastrointestinal (GI) tract. The first device was developed to examine the small bowel, previously inaccessible to endoscopic examination, for which it is now a first-line investigative modality. Most commonly, small bowel VCE is used in patients with suspected bleeding or to identify evidence of active Crohn’s disease (in patients with or without a prior history of the disease). Conventionally, VCE is undertaken after upper and lower gastrointestinal flexible endoscopy has failed to make a diagnosis. (Small bowel radiology or a patency capsule test should be considered prior to VCE to minimize the risk of capsule retention in patients at high risk of strictures, such as those with Crohn’s disease, a long history of ingestion of nonsteroidal anti-inflammatory drugs [NSAIDs], or obstructive symptoms.) VCE may also be used in patients with celiac disease, polyposis syndromes, and other small bowel disorders. Since the advent of small bowel capsule endoscopy (SBCE), dedicated esophageal and colon capsule endoscopes have expanded the fields of application to include the investigation of the upper and lower GI tract as well as midgut disorders. Esophageal capsule endoscopy (ECE) may be used to diagnose esophagitis, Barrett’s esophagus, and varices, but it cannot be relied on to identify gastroduodenal disease. Colon capsule endoscopy (CCE) offers an alternative to conventional colonoscopy for symptomatic patients, and a possible role in colon cancer screening is intriguing. Current research is already addressing the possibility of controlling capsule movement and developing capsules that allow tissue sampling and the administration of therapy.
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