Introduction The indications for and efficacy of device-assisted enteroscopy is not standardised in coeliac disease (CD). We present the largest study to date to evaluate the clinical role of double-balloon enteroscopy (DBE) in complicated CD.
Methods DBE findings in CD patients with suspected small bowel complications were retrospectively evaluated in two tertiary referral centres (Milan and Sheffield). Demographic data of the studied cohort were compared with a database of 1000 non complicated CD patients.
Results Findings from 14 oral and seven anal DBE in 19 CD cases (11 males p = 0.003 vs control database) were reviewed. Mean age at CD diagnosis (37 ± 19 vs. 27 ± 18) and at small bowel evaluation (49 ± 15 vs. 38 ± 13) was significantly higher in the DBE group compared to controls (p < 0.001). Indications for DBE were the follow up of known refractory coeliac disease (RCD) (#7), suspicion of small bowel complications due to gastrointestinal symptoms (#4), severe iron deficiency anaemia (#6) and long standing poor dietary adherence (#2). All DBE were performed after small bowel capsule endoscopy, except for one case. 3 patients from the known RCD group had evidence of TCRg monoclonality on biopsy (type 2 RCD). One of these patients had jejunal ulceration whilst the other 2 cases had areas with small white raised patches. A further RCD case had evidence of jejunal ulceration however biopsies didn’t show any evidence of TCRg monoclonality. A single RCD case had distally worsening atrophy. Patchy small bowel atrophy was observed in all the non adherent patients and in 2 patients with persistent gastrointestinal symptoms who had only been on a gluten free diet for a short time. Two jejunal adenocarcinomas and an ileal neuroendocrine tumour were detected. All 3 of these patients presented with iron deficiency anaemia.
Conclusion This is the largest international DBE outcomes study in CD patients. Even minor mucosal lesions seen at DBE may be associated with significant pathology. Evaluation of non-responsive/refractory symptoms by DBE was associated with older patients (p < 0.001) and a higher proportion of males (p = 0.003) than an uncomplicated CD population. Further studies are needed to better understand the clinical relevance of the small bowel endoscopic features and to optimise DBE indications.
Disclosure of Interest None Declared.
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