Capsule endoscopy has been increasingly used for diagnosing diseases of the small bowel.
It is an attractive technique for assessing celiac disease because it is noninvasive and provides a close and magnified view of the mucosa of the entire small bowel.
Dr Jeejeebhoy and colleagues from Canada evaluated the accuracy of capsule endoscopy and interobserver agreement in recognizing villous atrophy using histopathology as the reference.
The researchers also explored the extent of small bowel involvement with celiac disease and the relationship between the length of the affected bowel and the clinical presentation.
The research team included 10 patients with celiac disease with histologically proven villous atrophy and the same number of controls were subjected to capsule endoscopy.
|Capsule endoscopy was tolerated well by all study participants with 95% reporting absence of any discomfort|
|American Journal of Gastroenterology|
4 Investigators (2 with and 2 without prestudy capsule endoscopy experience) were blinded to histology findings and were asked to diagnose villous atrophy on capsule endoscopy images.
Based on assessment of all 4 investigators, the overall sensitivity, specificity, positive predictive value, and negative predictive value of capsule endoscopy in diagnosing villous atrophy were 70%, 100%, 100%, and 77%, respectively.
The investigators reported that sensitivity and specificity of the test was 100% when the reports of experienced capsule endoscopists only were analyzed.
The researchers noted that the interobserver agreement was perfect between investigators with prestudy capsule endoscopy experience and poor between the investigators who had limited prestudy exposure to capsule endoscopy.
The team observed that celiac patients with extensive small bowel involvement had typical symptoms of malabsorption (diarrhea, weight loss) as opposed to mild and nonspecific symptoms in patients whose disease was limited to the proximal small bowel.
In addition, the research team reported that capsule endoscopy was tolerated well by all study participants with 95% reporting absence of any discomfort.
Dr Jeejeebhoy concludes, “Although based on a small sample size, the study suggests that capsule endoscopy may be useful in assessing patients with celiac disease.
“Familiarity with capsule endoscopy technology appears to be a critical factor affecting the accuracy of the test.”
“Larger studies are warranted to more precisely define the advantages and limitations of capsule endoscopy in celiac disease.”