Maiden L, Elliott T, McLaughlin S D, Ciclitira P
Department of Gastroenterology, Guy's & St. Thomas' NHS Foundation Trust, London, UK.
Dig Dis Sci. 2009 Jun;54(6):1280-3. doi: 10.1007/s10620-008-0486-5. Epub 2008 Oct 31.
This study compares video capsule endoscopy (VCE) with histological specimens of proximal small bowel in patients with celiac disease who have failed to respond to a gluten-free diet. Patients with nonresponsive celiac disease underwent capsule endoscopy, and concordance between endoscopy and histology was then calculated using the kappa statistic. In 19 patients, endoscopy videos were reported as normal in ten (53%) case, as having mild changes in three (16%) cases, and as having moderate-severe changes in six (31%) cases. Two (11%) had acute ulcers. No small bowel tumors were seen. Endoscopy demonstrated concordance with histological changes in 14 of the 18 patients with histology available (78% concordance). The kappa statistic suggested a substantial degree of concordance between histology and endoscopic findings. Endoscopy with distal duodenal biopsies is superior to VCE in detecting proximal, nonresponsive celiac disease, but more distal lesions may be missed such that the strength of VCE lies in its ability to visualize the entire small bowel.
本研究比较了视频胶囊内镜检查（VCE）与乳糜泻患者近端小肠组织学标本的情况，这些患者对无麸质饮食无反应。对无反应性乳糜泻患者进行胶囊内镜检查，然后使用kappa统计量计算内镜检查与组织学之间的一致性。在19例患者中，内镜检查视频报告为正常的有10例（53%），有轻度改变的3例（16%），有中度至重度改变的6例（31%）。2例（11%）有急性溃疡。未发现小肠肿瘤。在18例有组织学结果的患者中，14例（一致性为78%）内镜检查结果与组织学改变一致。kappa统计量表明组织学与内镜检查结果之间有高度一致性。在检测近端无反应性乳糜泻方面，十二指肠远端活检的内镜检查优于VCE，但可能会遗漏更远端的病变，因此VCE的优势在于其能够观察整个小肠。
