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Role of capsule endoscopy in suspected celiac disease: A European multi-centre study

Autores: Lujan-Sanchís, M.; Pérez-Cuadrado-Robles, E.; García-Lledo, J.; Fernández, J. F. J.; Elli, L.; Jiménez-García, V. A.; Egea-Valenzuela, J.; Valle-Muñoz, J.; Carretero Ribón, Cristina; Fernández-Urien-Sáinz, I. ; López-Higueras, A.; Alonso-Lázaro, N.; Sanjuan-Acosta, M.; Sánchez-Ceballós, F.; Rosa, B.; González Vázquez, Santiago; Branchi, F.; Ruano-Diaz, L.; Prieto de Frías, César; Pons-Beltran, V.; Borque-Barrera, P. ; González-Suárez, B.; Xavier, S.; Arguelles-Arias, F.; Herrerías-Gutiérrez, J. M.; Pérez-Cuadrado-Martínez, E.; Sempere-García-Arguelles, J.
ISSN: 1007-9327
Volumen: 23
Número: 4
Páginas: 703 - 711
Fecha de publicación: 2017
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.