The role of capsule endoscopy in alarm features and non-responsive celiac disease: a European multi-centre study

Abstract

Objectives

The role of capsule endoscopy in established celiac disease remains unclear. Our objective was to analyse the usefulness of capsule endoscopy in the suspicion of complicated celiac disease.

Methods

This is a retrospective multi-centre study. One hundred eighty-nine celiac patients (mean age: 46.6±16.6, 30.2% males) who underwent capsule endoscopy for alarm symptoms (n=86, 45.5%) or non-responsive celiac disease (n=103, 54.5%) were included. Diagnostic yield, therapeutic impact and safety were analysed.

Results

Capsule endoscopy was completed in 95.2% of patients (small bowel transit time: 270.5±100.2 minutes). The global diagnostic yield was 67.2%, detecting atrophic mucosa (n=92, 48.7%), ulcerative jejunoileitis (n=21, 11.1%), intestinal lymphoma (n=7, 3.7%) and other enteropathies (n=7, 3.7%, six Crohn's disease cases and one neuroendocrine tumour).

The diagnostic yield of capsule endoscopy was significantly higher in patients presenting with non-responsive disease compared to patients with alarm symptoms (73.8% vs. 59.3%, p=0.035). The new findings of the capsule endoscopy modified management in 59.3% of the cases. There were no major complications.

Conclusions

Capsule endoscopy may be a moderately helpful and safe diagnostic tool in the suspicion of complicated celiac disease, modifying the clinical course of these patients.

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