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  • Title: Enteroscopy for the early detection of small bowel tumours in at-risk celiac patients.
    Author: Tomba C, Elli L, Bardella MT, Soncini M, Contiero P, Roncoroni L, Locatelli M, Conte D.
    Journal: Dig Liver Dis; 2014 May; 46(5):400-4. PubMed ID: 24440311.
    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.
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