Diagnostic Yield of Capsule Endoscopy in Refractory Celiac Disease
Diagnostic Yield of Capsule Endoscopy in Refractory Celiac Disease
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DOI：
10.1038/ajg.2012.199
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发表时间：
2012-10-01
影响因子：
9.8
通讯作者：
Cellier, Christophe
中科院分区：
文献类型：
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作者：
Barret, Maximilien;Malamut, Georgia;Cellier, Christophe
优点：胶囊式内窥镜（CE）可用于评估许多肠道疾病（包括乳糜泻（CD））中的小肠。CE的主要优点是肠粘膜表面的完全可视化。本研究的目的是探讨CE是否可以预测CD的严重程度和检测complications.METHODS：我们回顾性研究了9例有症状的CD患者，11例难治性乳糜泻I型（RCDI）和18例难治性乳糜泻II型（RCDII），和45例无CD患者的医疗档案，他们都进行了CE和上消化道内镜或肠镜检查。CD的类型是根据集中的组织学检查、上皮内淋巴细胞的流式细胞术分析和多重聚合酶链反应的T细胞受体重排分析来诊断的。共47个CE（症状性CD、RCDI和RCDII组分别有10、11和26例CE，对38例乳糜泻患者的47例CE和45例非乳糜泻患者的47例CE进行回顾性分析。绒毛萎缩，众多，或远端溃疡更常见于乳糜泻患者比对照组。在乳糜泻患者中，96%的病例CE质量可接受，62%的病例完成CE。CE与组织学诊断绒毛萎缩的一致性优于光学内镜（Kappa系数= 0.45 vs.0.24，P < 0.001）。CE时广泛的粘膜损伤与低血清白蛋白（P = 0.003）和RCDII形式（P = 0.02）相关。三例显性淋巴瘤检测CE在follow-up.CONCLUSIONS：CE结果有一个令人满意的一致性与组织学和营养状况的患者有症状或难治性CD。此外，CE可以预测RCD的类型，并允许早期发现显性淋巴瘤。
OBJECTIVES: Capsule endoscopy (CE) allows for the assessment of the small bowel in numerous intestinal diseases, including celiac disease (CD). The main advantage of CE is the complete visualization of the intestinal mucosal surface. The objective of this study was to investigate whether CE can predict the severity of CD and detect complications.METHODS: We retrospectively studied the medical files of 9 patients with symptomatic CD, 11 patients with refractory celiac disease type I (RCDI) and 18 patients with refractory celiac disease type II (RCDII), and 45 patients without CD who were investigated both CE and upper endoscopy or enteroscopy. The type of CD was diagnosed on the basis of a centralized histological review, flow cytometry analysis of intraepithelial lymphocytes, and the analysis of T-cell receptor rearrangement by multiplex polymerase chain reaction.RESULTS: A total of 47 CEs (10, 11, and 26 CEs in the symptomatic CD, RCDI, and RCDII groups, respectively) from the 38 celiac patients and 47 CEs from the 45 nonceliac patients were retrospectively reviewed. Villous atrophy, numerous, or distally located ulcers were more frequent in celiac patients than in controls. Among celiac patients, CE was of acceptable quality in 96% of cases and was complete in 62% of cases. The concordance of CE with histology for villous atrophy was better than that of optic endoscopy (kappa coefficient = 0.45 vs. 0.24, P < 0.001). Extensive mucosal damage on CE was associated with low serum albumin (P = 0.003) and the RCDII form (P = 0.02). Three cases of overt lymphoma were detected by CE during the follow-up.CONCLUSIONS: CE findings have a satisfactory concordance with histology and nutritional status in patients with symptomatic or refractory CD. Moreover, CE may predict the type of RCD and allows for the early detection of overt lymphoma.