Tomba Carolina, Sidhu Reena, Sanders David S, Mooney Peter D, Branchi Federica, Locatelli Martina, Roncoroni Leda, Conte Dario, Bardella Maria T, Elli Luca
*Department of Pathophysiology and Transplantation, Center for the Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico†Departments of Pathophysiology and Transplantation§Biomedical Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy‡Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield, UK.
J Clin Gastroenterol. 2016 Apr;50(4):313-7. doi: 10.1097/MCG.0000000000000424.
Indications to double-balloon enteroscopy (DBE) are not standardized in celiac disease (CD).
To evaluate the clinical usefulness of DBE in complicated CD.
DBE findings in celiac patients with suspected small bowel (SB) complications were retrospectively evaluated in 2 tertiary referral centers (Milan and Sheffield). Demographic data of the studied cohort were compared with a database of 1000 noncomplicated CD patients.
Twenty-four CD cases (12 males, P=0.01 vs. controls) were reviewed. Mean age at CD diagnosis (y±SD) was 37±20 versus 27±18 and at SB evaluation 47±15 versus 38±13 (P<0.01 compared with controls). Indications for DBE were refractory CD (#9), gastrointestinal symptoms (#6), severe iron-deficiency anemia (#6), and long standing poor dietary adherence (#3). Two jejunal adenocarcinomas and an ileal neuroendocrine tumor were detected in presence of iron-deficiency anemia. Three type I and 3 type II refractory CD patients showed jejunal ulcerations; 2 of type II presented small white raised patches. Patchy atrophy was observed in nonadherent patients and in 2 on a gluten-free diet for a short time. Therapy was planned in 33% of patients after DBE. No adverse events were detected at follow-up [21 mo (range, 0 to 60 mo)].
This is the largest international study on the outcomes of DBE in CD demonstrating its usefulness to exclude/confirm malignant or premalignant conditions, associated with even minor lesions. Studies are needed to understand the clinical relevance of the SB endoscopic features and to optimize DBE indications.
在乳糜泻（CD）中，双气囊小肠镜检查（DBE）的适应证尚无标准化。
评估DBE在复杂CD中的临床实用性。
在2个三级转诊中心（米兰和谢菲尔德）对疑似小肠（SB）并发症的乳糜泻患者的DBE检查结果进行了回顾性评估。将研究队列的人口统计学数据与1000例非复杂CD患者的数据库进行了比较。
共回顾了24例CD病例（12例男性，与对照组相比P=0.01）。CD诊断时的平均年龄（y±标准差）为37±20岁，而对照组为27±18岁；在进行SB评估时，平均年龄为47±15岁，而对照组为38±13岁（与对照组相比P<0.01）。DBE的适应证包括难治性CD（9例）、胃肠道症状（6例）、严重缺铁性贫血（6例）以及长期饮食依从性差（3例）。在缺铁性贫血患者中检测到2例空肠腺癌和1例回肠神经内分泌肿瘤。3例I型和3例II型难治性CD患者出现空肠溃疡；2例II型患者出现小白斑。在未坚持饮食治疗的患者以及2例短期采用无麸质饮食的患者中观察到斑片状萎缩。33%的患者在DBE检查后制定了治疗方案。随访期间[21个月（范围为0至60个月）]未发现不良事件。
这是关于DBE在CD中应用结果的最大规模国际研究，证明了其在排除/确认恶性或癌前病变（甚至与微小病变相关）方面的实用性。需要开展研究以了解SB内镜特征的临床相关性并优化DBE的适应证。
