Zammit Stefania Chetcuti, Elli Luca, Scaramella Lucia, Sanders David S, Tontini Gian Eugenio, Sidhu Reena
Gastroenterology Department, Sheffield Teaching Hospitals, United Kingdom (Stefania Chetcuti Zammit, David S. Sanders, Reena Sidhu).
Centre for Prevention and Diagnosis of Coeliac Disease, Gastroenterology and Endoscopy Unit, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Italy (Luca Elli, Lucia Scaramella, Gian Eugenio Tontini).
Ann Gastroenterol. 2021;34(2):188-195. doi: 10.20524/aog.2021.0586. Epub 2021 Jan 27.
Small bowel capsule endoscopy (SBCE) has an established role in the management of refractory celiac disease (RCD) for the detection of complications. The aim of this study was to define the role of SBCE in the management of patients with RCD.
Patients with histologically confirmed RCD who underwent successive SBCEs were recruited retrospectively from 2 tertiary centers.
Sixty patients with RCD were included. The percentage extent of the affected small bowel (SB) mucosa improved on repeating a second SBCE in 26 patients (49.1%) (median 27.6% vs. 18.1%, P=0.007). Patients with RCD type II had more extensive disease than those with RCD type I on first (41.4% vs. 19.2%, P=0.004) and second (29.8% vs. 12.0%, P=0.016) SBCE. Patients with RCD type I tended to show a greater improvement in percentage of abnormal SB involved on repeat SBCE compared to those with RCD type II (P=0.049). Nine patients (15%) had RCD-related complications. Five patients developed ulcerative jejunoileitis, 3 patients developed enteropathy-associated T-cell lymphoma, and 1 patient developed cutaneous T-cell lymphoma.
SBCE can be a useful tool for monitoring the effects of treatment, primarily following its initiation. Patients with RCD type II have more extensive SB disease, equating to a more aggressive disease pattern.
小肠胶囊内镜检查（SBCE）在难治性乳糜泻（RCD）并发症检测的管理中具有既定作用。本研究的目的是明确SBCE在RCD患者管理中的作用。
从2个三级中心回顾性招募经组织学确诊为RCD且接受连续SBCE检查的患者。
纳入60例RCD患者。26例患者（49.1%）在重复进行第二次SBCE时，受累小肠（SB）黏膜的受累范围百分比有所改善（中位数分别为27.6%和18.1%，P = 0.007）。II型RCD患者在首次（41.4%对19.2%，P = 0.004）和第二次（29.8%对12.0%，P = 0.016）SBCE时的病变范围比I型RCD患者更广泛。与II型RCD患者相比，I型RCD患者在重复SBCE时受累异常SB的百分比改善更明显（P = 0.049）。9例患者（15%）发生了RCD相关并发症。5例患者发生溃疡性空肠回肠炎，3例患者发生肠病相关T细胞淋巴瘤，1例患者发生皮肤T细胞淋巴瘤。
SBCE可以作为监测治疗效果的有用工具，主要是在治疗开始后。II型RCD患者的SB疾病范围更广泛，等同于更具侵袭性的疾病模式。
