Sequential CE-DBE Approach Detects CD-Related Complications

TOPLINE:

Capsule endoscopy (CE) and double-balloon enteroscopy (DBE) identify complications beyond the reach of conventional bidirectional endoscopy in patients with persistent symptoms of celiac disease.

METHODOLOGY:

• Guidelines recommend CE followed by device-assisted enteroscopy for the diagnosis and monitoring of nonresponsive or refractory celiac disease, although real-world evidence suggests that many practices may forego CE.
• Researchers conducted a retrospective analysis of two prospectively maintained databases with information on 132 adult patients (median age, 53 years; 64.4% women) with biopsy-proven celiac disease.
• Patients were categorized into four groups based on the indication for CE or DBE: Seronegative celiac disease (n = 17), nonresponsive celiac disease (n = 87), refractory celiac disease type 1 (n = 20), and refractory celiac disease type 2 (n = 8).
• Patients underwent 146 CEs and/or 25 DBEs. The median follow-up period after CE was 17.4 months.
• Patient outcomes were recorded on the basis of the last outpatient clinic letters and included discharge, ongoing management, follow-up, or death.

TAKEAWAY:

• The overall detection rate of CE was 87.6%, with atrophy being the most common finding (85.6%). Findings suggestive of villous atrophy were detected in the proximal small bowel in most cases (73.6%). The overall detection rate of DBE was 92%.
• Complications of celiac disease otherwise beyond the reach of conventional bidirectional endoscopy (eg, ulcerative jejunitis, strictures, and suspected malignancies) were detected in 10.6% of patients following CE and DBE.
• Patients with refractory celiac disease type 2 were more likely to be older than 50 years, report weight loss, and have anemia than those in other groups.
• Seven patients (5.5%) died during follow-up, all of whom had evidence of ongoing atrophy; five of those deaths (71.4%) were attributed to celiac disease–related malnutrition or malignancies.

IN PRACTICE:

“Identifying patients at high risk of complications and integrating CE and DBE in the diagnostic algorithm of patients with CD [celiac disease] and persistent villous atrophy could improve patient outcomes,” the authors wrote.

SOURCE:

The study, led by Mohamed G. Shiha, MBBCh, MRCP, Academic Unit of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, England, was published online in Digestive and Liver Disease.

LIMITATIONS: 

The retrospective analysis of the prospectively maintained clinical databases posed inherent limitations such as selection bias and residual confounding variables. The study was conducted at a single national center, which may have limited the generalizability of the findings to other clinical settings. The short median follow-up period may have led to an underestimation of the mortality rate. 

DISCLOSURES:

One author reported receiving grant funding from a Clinical Lecturers grant from the National Institute for Health and Care Research. All the authors declared no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.