Carolina Tomba1, Luca Elli2, Maria Teresa Bardella2, Marco Soncini3, Paolo Contiero4, Leda Roncoroni2, Martina Locatelli2, Dario Conte2. 1. 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. 2. 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. 3. Gastroenterology Unit, Azienda Ospedaliera Ospedale San Carlo Borromeo, via Pio II 3, 20153 Milan, Italy. 4. SC Registro Tumori ed Epidemiologia Ambientale, Fondazione IRCCS Istituto Nazionale Tumori, via Venezian 1, 20133 Milan, Italy.
Abstract
BACKGROUND: A subset of celiac patients shows a high risk for small bowel malignancies. AIMS: 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.
BACKGROUND: A subset of celiac patients shows a high risk for small bowel malignancies. AIMS: 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.