Background: Indications to double-balloon enteroscopy (DBE) are not standardized in celiac disease (CD). Goals: To evaluate the clinical usefulness of DBE in complicated CD. Study: 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. Results: 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)]. Conclusions: 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.

Celiac disease and double-balloon enteroscopy : What can we achieve? / C. Tomba, R. Sidhu, D.S. Sanders, P.D. Mooney, F. Branchi, M. Locatelli, L. Roncoroni, D. Conte, M.T. Bardella, L. Elli. - In: JOURNAL OF CLINICAL GASTROENTEROLOGY. - ISSN 0192-0790. - 50:4(2016 Apr), pp. 313-317. [10.1097/MCG.0000000000000424]

Celiac disease and double-balloon enteroscopy : What can we achieve?

C. Tomba
Primo
;
F. Branchi;L. Roncoroni;D. Conte;M.T. Bardella
Penultimo
;
L. Elli
Ultimo
2016

Abstract

Background: Indications to double-balloon enteroscopy (DBE) are not standardized in celiac disease (CD). Goals: To evaluate the clinical usefulness of DBE in complicated CD. Study: 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. Results: 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)]. Conclusions: 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.
celiac disease; enteroscopy; small bowel tumors; medicine (all); gastroenterology
Settore MED/12 - Gastroenterologia
Article (author)
File in questo prodotto:
File Dimensione Formato  
JournalClinicGastroEnterology_CeliacDisease_2016.pdf

accesso riservato

Tipologia: Publisher's version/PDF
Dimensione 161.2 kB
Formato Adobe PDF
161.2 kB Adobe PDF   Visualizza/Apri   Richiedi una copia
Pubblicazioni consigliate

Caricamento pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/433525
Citazioni
  • ???jsp.display-item.citation.pmc??? 6
  • Scopus 21
  • ???jsp.display-item.citation.isi??? 19
social impact