title: The value of double-balloon enteroscopy in patients with refractory celiac disease.
abstract: OBJECTIVE
  Patients with refractory celiac disease can develop enteropathy-associated T-cell lymphoma (EATL) or ulcerative jejunitis. Double-balloon enteroscopy allows examination of the small bowel. We prospectively assessed the value of this technique in patients with refractory celiac disease in a tertiary referral center.
  
  
  METHODS
  Small bowel enteroscopy was performed in a total of 21 consecutive patients for lesions like ulcerations (high risk). Biopsy specimens were taken from such lesions and from examined small bowel at three different levels of scope insertion depth. Tissue specimens were evaluated for the modified Marsh classification and for the presence of EATL.
  
  
  RESULTS
  Twenty-four procedures were successfully performed without complications. EATL was found in five patients (24%, 95% CI 10-45%) as circumferential, discrete, or confluent ulcerations. In three of them, Marsh III was found while in the other two patients with EATL Marsh I was found. Another two patients (9%, 95% CI 2-28%) had ulcerative jejunitis in the absence of EATL and histology was compatible with Marsh III. In the remaining 14 patients (54%, 95% CI 35-73%), no high-risk lesions were found. Double-balloon enteroscopy could exclude the presence of EATL in four patients that was suggested by abdominal computerized tomography.
  
  
  CONCLUSIONS
  Complications of refractory celiac disease like ulcerative jejunitis or EATL could efficiently be detected or excluded by double-balloon enteroscopy. This technique should be reserved for patients with refractory celiac disease or patients with a past history of EATL.
authors: Department of Gastroenterology, VU University Medical Center, Amsterdam, The Netherlands.
authors: Muhammed
authors: M
authors: Hadithi
authors: Abdulbaqi
authors: A
authors: Al-toma
authors: Joost
authors: J
authors: Oudejans
authors: Adriaan A
authors: AA
authors: van Bodegraven
authors: Chris J
authors: CJ
authors: Mulder
authors: Maarten
authors: M
authors: Jacobs
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002446:Celiac Disease / Q000473:pathology*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006801:Humans; D007414:Intestinal Neoplasms / Q000473:pathology; D007421:Intestine, Small / Q000473:pathology; D007579:Jejunal Diseases / Q000473:pathology; D016399:Lymphoma, T-Cell / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome