Luján-Sanchis Marisol, Pérez-Cuadrado-Robles Enrique, García-Lledó Javier, Juanmartiñena Fernández José-Francisco, Elli Luca, Jiménez-García Victoria-Alejandra, Egea-Valenzuela Juan, Valle-Muñoz Julio, Carretero-Ribón Cristina, Fernández-Urién-Sainz Ignacio, López-Higueras Antonio, Alonso-Lázaro Noelia, Sanjuan-Acosta Mileidis, Sánchez-Ceballos Francisco, Rosa Bruno, González-Vázquez Santiago, Branchi Federica, Ruano-Díaz Lucía, Prieto-de-Frías César, Pons-Beltrán Vicente, Borque-Barrera Pilar, González-Suárez Begoña, Xavier Sofía, Argüelles-Arias Federico, Herrerías-Gutiérrez Juan-Manuel, Pérez-Cuadrado-Martínez Enrique, Sempere-García-Argüelles Javier
Marisol Luján-Sanchis, Javier Sempere-García-Argüelles, Digestive Diseases Unit, General University Hospital of Valencia, 46026 Valencia, Spain.
World J Gastroenterol. 2017 Jan 28;23(4):703-711. doi: 10.3748/wjg.v23.i4.703.
To analyze the diagnostic yield (DY), therapeutic impact (TI) and safety of capsule endoscopy (CE).
This is a multi-centre, observational, analytical, retrospective study. A total of 163 patients with suspicion of celiac disease (CD) (mean age = 46.4 ± 17.3 years, 68.1% women) who underwent CE from 2003 to 2015 were included. Patients were divided into four groups: seronegative CD with atrophy (Group-I, = 19), seropositive CD without atrophy (Group-II, = 39), contraindication to gastroscopy (Group-III, = 6), seronegative CD without atrophy, but with a compatible context (Group-IV, = 99). DY, TI and the safety of CE were analysed.
The overall DY was 54% and the final diagnosis was villous atrophy ( = 65, 39.9%), complicated CD ( = 12, 7.4%) and other enteropathies ( = 11, 6.8%; 8 Crohn's). DY for groups I to IV was 73.7%, 69.2%, 50% and 44.4%, respectively. Atrophy was located in duodenum in 24 cases (36.9%), diffuse in 19 (29.2%), jejunal in 11 (16.9%), and patchy in 10 cases (15.4%). Factors associated with a greater DY were positive serology (68.3% 49.2%, = 0.034) and older age ( = 0.008). On the other hand, neither sex nor clinical presentation, family background, positive histology or HLA status were associated with DY. CE results changed the therapeutic approach in 71.8% of the cases. Atrophy was associated with a greater TI (92.3% 45.3%, < 0.001) and 81.9% of the patients responded to diet. There was one case of capsule retention (0.6%). Agreement between CE findings and subsequent histology was 100% for diagnosing normal/other conditions, 70% for suspected CD and 50% for complicated CD.
CE has a high DY in cases of suspicion of CD and it leads to changes in the clinical course of the disease. CE is safe procedure with a high degree of concordance with histology and it helps in the differential diagnosis of CD.
分析胶囊内镜（CE）的诊断率（DY）、治疗影响（TI）及安全性。
这是一项多中心、观察性、分析性、回顾性研究。纳入了2003年至2015年期间接受CE检查的163例疑似乳糜泻（CD）患者（平均年龄 = 46.4 ± 17.3岁，女性占68.1%）。患者分为四组：伴有萎缩的血清阴性CD（第一组，n = 19）、无萎缩的血清阳性CD（第二组，n = 39）、胃镜检查禁忌（第三组，n = 6）、无萎缩但有相关背景的血清阴性CD（第四组，n = 99）。分析了CE的DY、TI及安全性。
总体DY为54%，最终诊断为绒毛萎缩（n = 65，39.9%）、复杂性CD（n = 12，7.4%）和其他肠病（n = 11，6.8%；8例克罗恩病）。第一组至第四组的DY分别为73.7%、69.2%、50%和44.4%。萎缩位于十二指肠24例（36.9%）、弥漫性19例（29.2%）、空肠11例（16.9%）、斑片状10例（15.4%）。与较高DY相关的因素为血清学阳性（68.3%对49.2%，P = 0.034）和年龄较大（P = 0.008）。另一方面，性别、临床表现、家族史、组织学阳性或HLA状态均与DY无关。CE结果在71.8%的病例中改变了治疗方法。萎缩与较高的TI相关（92.3%对45.3%，P < 0.001），81.9%的患者对饮食有反应。有1例胶囊滞留（0.6%）。CE检查结果与后续组织学诊断正常/其他情况的一致性为100%，疑似CD为70%，复杂性CD为50%。
在疑似CD的病例中，CE具有较高的DY，并能导致疾病临床进程的改变。CE是一种安全的检查方法，与组织学高度一致，有助于CD的鉴别诊断。
