CHICAGO — Video capsule endoscopy appears to equal duodenal histology in detecting villous atrophy and should be used for first-line evaluation of refractory celiac disease, investigators reported at the annual Digestive Disease Week.
Two multicenter trials showed preliminary results with the new PillCam SB capsule endoscope, a pill-sized disposable camera that patients swallow and within 24 hours pass naturally.
The technique allows noninvasive examination of the entire length of the small intestine, according to Dr. med. Norbert Krauss, of Friedrich-Alexander University Hospital, Erlangen-Nuremberg, Germany.
His study, a prospective, blinded European trial, compared video capsule endoscopy with the gold standard—upper-GI endoscopy and duodenal biopsies—in 60 patients with diagnosed celiac disease.
The other study, directed by Roberto de Franchis, M.D., from the University of Milan (Italy), compared capsule endoscopy with upper GI endoscopy in 25 patients suspected of having the gluten-sensitive enteropathy.
In the first pilot study, the patients either had persistent symptoms despite more than a year of a strict gluten-free diet (44 patients) or were newly diagnosed and were not yet on a gluten-free diet (16 controls).
A dietitian verified that patients had complied with the gluten-free diet.
Two blinded reviewers interpreted the available results for 43 of the 44 patients.
Dr. Krauss said he and his colleagues found a good correlation between the two imaging techniques in both groups.
With video capsule endoscopy, all untreated controls showed typical villous atrophy and mucosal alterations, which involved the whole small intestine in three controls.
Of the 43 patients, 34 had mucosal alterations evident on the video, 2 of whom had the entire small intestine affected.
During the video recording, two patients did not show a sufficient view and in the other, the capsule did not reach the duodenum.
In addition, the new device detected ulcers in 23% of the patients with celiac disease.
“We saw many more pathologies with capsule endoscopy,” Dr. Krauss said. “I think capsule endoscopy is very important in those patients who have symptoms on a gluten-free diet.”
Dr. de Franchis reported that the aim of his study was to evaluate the potential of video capsule endoscopy, compared with conventional upper endoscopy, in detecting villous atrophy in patients with suspected celiac disease.
Whereas the conventional method showed villous atrophy in 18 of the 25 patients, capsule endoscopy found the abnormality in those plus an additional patient, he said.
The sensitivity and specificity of capsule endoscopy were 95% and 86%, respectively. Dr. de Franchis reported that the investigators did not use capsule endoscopy to test for conditions similar to celiac disease.
“PillCam endoscopy appears to be equivalent to duodenal histology in determination of villous atrophy in patients with celiac disease,” Dr. de Franchis said.
Dr. Krauss added that video capsule endoscopy should be used as the first-line evaluation in patients with confirmed celiac disease that have proved to be nonresponsive to a gluten-free diet, to exclude lymphoma, and to delineate the expansion of mucosal alterations.