title: Celiac Disease and Double-Balloon Enteroscopy: What Can We Achieve?: The Experience of 2 European Tertiary Referral Centers.
abstract: BACKGROUND
  Indications to double-balloon enteroscopy (DBE) are not standardized in celiac disease (CD).
  
  
  OBJECTIVE
  To evaluate the clinical usefulness of DBE in complicated CD.
  
  
  METHODS
  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.
authors.affiliation: *Department of Pathophysiology and Transplantation, Center for the Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico†Departments of Pathophysiology and Transplantation§Biomedical Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy‡Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield, UK.
authors.forename: Carolina
authors.initials: C
authors.lastname: Tomba
authors.forename: Reena
authors.initials: R
authors.lastname: Sidhu
authors.forename: David S
authors.initials: DS
authors.lastname: Sanders
authors.forename: Peter D
authors.initials: PD
authors.lastname: Mooney
authors.forename: Federica
authors.initials: F
authors.lastname: Branchi
authors.forename: Martina
authors.initials: M
authors.lastname: Locatelli
authors.forename: Leda
authors.initials: L
authors.lastname: Roncoroni
authors.forename: Dario
authors.initials: D
authors.lastname: Conte
authors.forename: Maria T
authors.initials: MT
authors.lastname: Bardella
authors.forename: Luca
authors.initials: L
authors.lastname: Elli
mesh_terms: D000328:Adult; D053704:Capsule Endoscopy; D002446:Celiac Disease / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D058582:Double-Balloon Enteroscopy; D004739:England; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000473:pathology*; D007558:Italy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D055815:Young Adult