Video capsule enteroscopy in the diagnosis of celiac disease: a multicenter study.
OBJECTIVE
Duodenal biopsy is the current gold standard for diagnosis of celiac disease. Videocapsule endoscopy examines the entire small bowel and allows visualization of mucosal villi. We evaluated the potential of videocapsule endoscopy in assessing the severity and extent of mucosal changes in patients with suspected celiac disease.


METHODS
Consecutive patients with signs/symptoms suggesting celiac disease and positive anti-gliadin and/or anti-endomysial and/or anti-tissue transglutaminase antibodies underwent upper gastrointestinal endoscopy and videocapsule endoscopy. Duodenal biopsies were classified according to modified Marsh's criteria. Capsule findings were evaluated for the presence of lesions compatible with celiac disease (scalloping of duodenal folds, fissures, flat mucosa, and mosaic appearance).


RESULTS
Forty-three patients were studied. Duodenal histology was normal in 11 and compatible with celiac disease in 32. Using duodenal histology as the gold standard, the performance characteristics of capsule endoscopy for the diagnosis of celiac disease were: sensitivity 87.5% (95% CI 76.1-98.9%), specificity 90.9% (95% CI 81.0-100%), positive predictive value 96.5% (95% CI 90.1-100%), negative predictive value 71.4% (95% CI 55.8-87%), positive and negative likelihood ratios 9.6 and 0.14, respectively. Eighteen patients had mucosal changes extending beyond the duodenum, involving the entire small bowel in three. These patients tended to have more severe symptoms, but the difference was not statistically significant. Interobserver agreement for the diagnosis of celiac disease by capsule endoscopy ranged between 79.2 and 94.4%; kappa values ranged between 0.56 and 0.87.


CONCLUSIONS
Videocapsule endoscopy shows good sensitivity and excellent specificity for the detection of villous atrophy in patients with suspected celiac disease.
Rondonotti
Emanuele
E
Department of Medical Sciences, University of Milan and Gastroenterology and GI Endoscopy Unit, Ospedale Maggiore Policlinico, Mangiagalli and Regina Elena Foundation, Milan, Italy.
Spada
Cristiano
C
Cave
David
D
Pennazio
Marco
M
Riccioni
Maria E
ME
De Vitis
Italo
I
Schneider
David
D
Sprujevnik
Tatiana
T
Villa
Federica
F
Langelier
Jennifer
J
Arrigoni
Arrigo
A
Costamagna
Guido
G
de Franchis
Roberto
R
D053704:Capsule Endoscopy; D002446:Celiac Disease / Q000473:pathology*; D004384:Duodenoscopy / Q000379:methods*; D004386:Duodenum / Q000473:pathology; D006801:Humans; D015588:Observer Variation; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity