Endoscopy 2019; 51(04): S31
DOI: 10.1055/s-0039-1681261
ESGE Days 2019 oral presentations
Friday, April 5, 2019 11:00 – 13:00: Capsule – enteroscopy Club B
Georg Thieme Verlag KG Stuttgart · New York

THE ROLE OF CAPSULE ENTEROSCOPY IN COELIAC DISEASE: RESULTS OF A PROSPECTIVE STUDY IN A TERTIARY REFERRAL CENTER

L Elli
1   Center for the Prevention of Celiac Disease, Gastroenterology and Endoscopy Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy
,
B Marinoni
1   Center for the Prevention of Celiac Disease, Gastroenterology and Endoscopy Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy
,
M Topa
2   Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
,
L Roncoroni
1   Center for the Prevention of Celiac Disease, Gastroenterology and Endoscopy Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy
,
M Vecchi
1   Center for the Prevention of Celiac Disease, Gastroenterology and Endoscopy Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy
2   Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

Coeliac disease (CD) is a chronic enteropathy, rarely complicated with refractory disease (RCD type1, 2) and malignancies. Capsule enteroscopy (CE) is a useful tool to evaluate patients with persistence or recurrence of symptoms despite an ongoing gluten free diet (GFD). The aim of this study was to evaluate the diagnostic performance of CE in detecting CD-related complications.

Methods:

Between 2014 and 2017 we prospectively enrolled patients undergoing CE for suspected complicated CD, non-adherence to GFD or for follow-up in known RCD. CE was defined as positive in case of CD-related findings in SB (i.e. atrophy, erosions, ulcers or masses). Patients with a final diagnosis of RCD or malignancy were defined as complicated CD.

Results:

121 CD patients were enrolled and 143 CE were performed. 61% of patients underwent CE for suspected CD complication, 25% for non-adherence to GFD and 14% for RCD follow-up. The mean follow-up time after CE was 13 ± 9 months. As a result, 17% were diagnosed as complicated CD (11 RCD-type1, 8 RCD-type2 and 2 lymphoma). CD-related findings were detected in 55%. CE sensitivity for the detection of mucosal atrophy was 62% and specificity was 81%. The incidence of complications in patients with suspected complicated CD and non-adherence to GFD was 5.7%. Among patients with known RCD, two patients (1.6%) developed EATL. Patients with positive CE were significantly older at CD diagnosis compared to patients with negative CE (p = 0.005). Moreover, CD-related findings were more frequently detected in patients aged > 50 years old (p = 0.01). Any statistical correlation was found with positive CD serology and incorrect GFD (p > 0.05).

Conclusions:

CE plays a pivotal role in detecting atrophy, extension of SB lesions and in identifying CD-related complications. According to our results, complicated CD is an uncommon condition; however patients aged > 50 years old and with older age at CD diagnosis should be considered at higher risk of complications, thus accurately investigated with CE.