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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2017; 23(4): 703-711
Published online Jan 28, 2017. doi: 10.3748/wjg.v23.i4.703
Role of capsule endoscopy in suspected celiac disease: A European multi-centre study
Marisol Luján-Sanchis, Enrique Pérez-Cuadrado-Robles, Javier García-Lledó, José-Francisco Juanmartiñena Fernández, Luca Elli, Victoria-Alejandra Jiménez-García, Juan Egea-Valenzuela, Julio Valle-Muñoz, Cristina Carretero-Ribón, Ignacio Fernández-Urién-Sainz, Antonio López-Higueras, Noelia Alonso-Lázaro, Mileidis Sanjuan-Acosta, Francisco Sánchez-Ceballos, Bruno Rosa, Santiago González-Vázquez, Federica Branchi, Lucía Ruano-Díaz, César Prieto-de-Frías, Vicente Pons-Beltrán, Pilar Borque-Barrera, Begoña González-Suárez, Sofía Xavier, Federico Argüelles-Arias, Juan-Manuel Herrerías-Gutiérrez, Enrique Pérez-Cuadrado-Martínez, Javier Sempere-García-Argüelles
Marisol Luján-Sanchis, Javier Sempere-García-Argüelles, Digestive Diseases Unit, General University Hospital of Valencia, 46026 Valencia, Spain
Enrique Pérez-Cuadrado-Robles, Antonio López-Higueras, Enrique Pérez-Cuadrado-Martínez, Small Bowel Unit, Hospital Morales Meseguer, 30008 Murcia, Spain
Javier García-Lledó, Digestive Diseases Unit, General University Gregorio Marañón, 28007 Madrid, Spain
José-Francisco Juanmartiñena Fernández, Ignacio Fernández-Urién-Sainz, Unit of Gastroenterology and Endoscopy, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain
Luca Elli, Federica Branchi, Center for prevention and Diagnosis of Celiac Disease, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
Victoria-Alejandra Jiménez-García, Federico Argüelles-Arias, Juan-Manuel Herrerías-Gutiérrez, Unit of Gastroenterology and Endoscopy, University Hospital Virgen Macarena, 41071 Sevilla, Spain
Juan Egea-Valenzuela, Gastroenterology department, Hospital Virgen de la Arrixaca, 30120 Murcia, Spain
Julio Valle-Muñoz, Lucía Ruano-Díaz, Department of Gastroenterology, Complejo Hospitalario de Toledo, 45005 Toledo, Spain
Cristina Carretero-Ribón, Santiago González-Vázquez, César Prieto-de-Frías, Department of Gastroenterology, University of Navarra Clinic, 31009 Pamplona, Spain
Noelia Alonso-Lázaro, Vicente Pons-Beltrán, Endoscopy Digestive Unit, Digestive Diseases Area, Universitari i Politècnic La Fe Hospital, 46026 Valencia, Spain
Mileidis Sanjuan-Acosta, Pilar Borque-Barrera, Digestive Diseases Unit, University Hospital Nuestra Señora de Candelaria, 38010 Tenerife, Spain
Francisco Sánchez-Ceballos, Digestive Diseases Unit, Clinical Hospital San Carlos, 28040 Madrid, Spain
Bruno Rosa, Sofía Xavier, Digestive Diseases Unit, Hospital da Senhora da Oliveira - Guimarães, 114 Cutileiros, Portugal
Begoña González-Suárez, Endoscopy Digestive Unit, Hospital Clinic de Barcelona, 08036 Barcelona, Spain
Author contributions: Luján-Sanchis M has designed and coordinated the study, literature review and drafted the manuscript; Pérez-Cuadrado-Robles E performed the analysis and interpretation of data; the remaining authors equally contributed to this paper with acquisition of data, critical revision and final approval of the final version to be published.
Institutional review board statement: The study was reviewed and approved by the Research Foundation of Hospital General Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Marisol Luján-Sanchis, MD, PhD, Digestive Diseases Unit, General University Hospital of Valencia, Avenida Tres Cruces 2, 46014 Valencia, Spain. marisol.lujan@hotmail.es
Telephone: +34-96-3131800 Fax: +34-96-1972148
Received: November 3, 2016
Peer-review started: November 4, 2016
First decision: December 1, 2016
Revised: December 8, 2016
Accepted: January 4, 2017
Article in press: January 4, 2017
Published online: January 28, 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.
Core tip: We present the experience of 14 European centers in the indication of impact of capsule endoscopy for suspected celiac disease. It is the study with more patients published to date. We describe the diagnostic and therapeutic impact of capsule in celiac disease, as well as the safety of the technique for this indication.
