Enteroscopy for the early detection of small bowel tumours in at-risk celiac patients.
BACKGROUND
A subset of celiac patients shows a high risk for small bowel malignancies.


OBJECTIVE
To select celiac patients considered at risk and evaluate the diagnostic yield of enteroscopy in this context.


METHODS
Celiac patients were enrolled from a tertiary referral centre during the period June 2011-June 2013, based on the following criteria: (i) patients diagnosed when aged 50+ and with poor response to gluten-free dieting; (ii) low dietary compliance; (iii) alarm symptoms. The patients underwent small bowel capsule endoscopy and/or double-balloon enteroscopy. Control populations were represented by the 165 non-celiac patients undergoing capsule endoscopy for obscure gastrointestinal bleeding, and the 815,362-strong population of the Italian province of Varese as a registered cohort.


RESULTS
Fifty-three patients (19% males, mean age 43.6±17.4 years) were evaluated. Two jejunal adenocarcinomas and one ileal neuro-endocrine tumour were diagnosed by enteroscopy (the diagnostic yield for malignancies in the selected population being 5.7%). In the non-celiac controls the detection rate of small bowel tumours by capsule endoscopy was 0.6% (P=0.04). When compared to the registered population, the relative risk for intestinal malignancy was 1282 (95% CI, 407-4033; P<0.0001).


CONCLUSIONS
Capsule endoscopy and double-balloon enteroscopy can be considered for early disease management of a subset of celiac patients.
Center for the Prevention and Diagnosis of Celiac Disease and Gastroenterology Unit II, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Università degli Studi di Milano, via F. Sforza 35, 20122 Milan, Italy. Electronic address: tomba.carolina@gmail.com.
Carolina
C
Tomba
Center for the Prevention and Diagnosis of Celiac Disease and Gastroenterology Unit II, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Università degli Studi di Milano, via F. Sforza 35, 20122 Milan, Italy.
Luca
L
Elli
Center for the Prevention and Diagnosis of Celiac Disease and Gastroenterology Unit II, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Università degli Studi di Milano, via F. Sforza 35, 20122 Milan, Italy.
Maria Teresa
MT
Bardella
Gastroenterology Unit, Azienda Ospedaliera Ospedale San Carlo Borromeo, via Pio II 3, 20153 Milan, Italy.
Marco
M
Soncini
SC Registro Tumori ed Epidemiologia Ambientale, Fondazione IRCCS Istituto Nazionale Tumori, via Venezian 1, 20133 Milan, Italy.
Paolo
P
Contiero
Center for the Prevention and Diagnosis of Celiac Disease and Gastroenterology Unit II, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Università degli Studi di Milano, via F. Sforza 35, 20122 Milan, Italy.
Leda
L
Roncoroni
Center for the Prevention and Diagnosis of Celiac Disease and Gastroenterology Unit II, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Università degli Studi di Milano, via F. Sforza 35, 20122 Milan, Italy.
Martina
M
Locatelli
Center for the Prevention and Diagnosis of Celiac Disease and Gastroenterology Unit II, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Università degli Studi di Milano, via F. Sforza 35, 20122 Milan, Italy.
Dario
D
Conte
D000230:Adenocarcinoma / Q000175:diagnosis*; D000328:Adult; D000740:Anemia / Q000209:etiology; D053704:Capsule Endoscopy; D002446:Celiac Disease / Q000150:complications*; D058582:Double-Balloon Enteroscopy / Q000009:adverse effects; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006801:Humans; D007078:Ileal Neoplasms / Q000175:diagnosis*; D007580:Jejunal Neoplasms / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000175:diagnosis*; D018579:Patient Selection; D011446:Prospective Studies; D012307:Risk Factors
Celiac disease; Enteroscopy; Malignancies; Small bowel