Elsevier

Gastrointestinal Endoscopy

Volume 86, Issue 2, August 2017, Pages 264-273.e1
Gastrointestinal Endoscopy

Systematic review and meta-analysis
Use of enteroscopy for the detection of malignant and premalignant lesions of the small bowel in complicated celiac disease: a meta-analysis

https://doi.org/10.1016/j.gie.2017.04.006Get rights and content

Background and Aims

Enteroscopy (wireless or wired) is the reference standard for small-bowel (SB) diseases, and it has been applied to detect SB malignancies in complicated celiac disease (CD) with heterogeneous results. The aim of this meta-analysis was to obtain a diagnostic yield (DY) by pooling the data of studies that investigated the use of enteroscopy to detect SB adverse events in CD.

Methods

We performed an online search for studies estimating the DY of wireless and wired enteroscopy in predicting the presence of SB premalignant and/or malignant lesions. The DerSimonian and Laird random-effects method was used to pool the arcsine-transformed proportions of patients with the events. Three meta-analyses were performed considering the following events: the presence of a malignancy, premalignant damage (ulcerative jejunoileitis [UJ]), or the presence of a malignancy or UJ. A subgroup analysis was performed after extracting (if possible) patients with refractory CD (RCD).

Results

Of the 529 titles initially resulting from the search, 10 studies on capsule enteroscopy (CE) and 3 on double-balloon or push enteroscopy met the inclusion criteria. Overall, 439 and 76 patients were enrolled in these studies using CE and enteroscopy, respectively. Twelve tumors and 47 UJs were found by CE versus 8 tumors and 13 UJs detected by wired enteroscopy. For malignancies the CE yield was 1.9% (95% CI, .5%-3.8%) and wired enteroscopy yield 8.7% (95% CI, 0%-21.2%); similarly, for UJ the DYs were 8.4% (95% CI, 2.1%-17.7%) and 16.7% (95% CI, 8.7%-26.3%); for either UJ or neoplasia the DYs were 13.0% (95% CI, 5.6%-22.5%) and 27.7% (95% CI, 14.8%-42.6%). For RCD the DYs of all enteroscopic techniques were 1.8% (95% CI, 0%-7.7%) for neoplasia, 22.3% (95% CI, 8.2%-39.7%) for UJ, and 27.5% (95% CI, 13.1%-44.2%) for either.

Conclusions

Enteroscopy is a powerful and efficient diagnostic tool for the detection of SB malignancies in complicated CD.

Section snippets

Protocol and criteria applied

The Preferred Reporting System for Systematic Reviews and Meta-Analyses was used as a guideline. The inclusion criteria for article types were prospective or retrospective, observational or comparative studies in which enteroscopic techniques were performed with the intention to detect any possible adverse event in CD patients with a complicated course. Case reports, congress reports, commentaries, editorials, and review articles were excluded from the analysis. Also, any study planned for the

Results

The literature search initially returned 529 studies from the CE search strategy and 183 from the wired enteroscopy strategy. Of all, 10 studies for CE11, 12, 14, 15, 16, 18, 19, 20, 22, 23 and 3 for wired enteroscopy13, 17, 21 met the inclusion criteria and were eligible for meta-analysis. No cases of discordance occurred among the 3 reviewers. Figure 1 reports the literature search flowcharts. Tables 1 and 2 report the clinical and demographic characteristics of the analyzed 10 CE and 3 wired

Discussion

To the best of our knowledge, this is the first meta-analysis to investigate the use of enteroscopy as a screening tool for the detection of SB malignant and premalignant lesions in the “complicated CD” scenario. From the present meta-analysis, enteroscopy has resulted in a DY of about 20% for malignancies and premalignant lesions originating from the SB mucosal layer. This is highly important for patient prognosis and management, because the diagnosis of EATL, SB adenocarcinoma, or UJ implies

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    DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. Research support for this study was provided in part by grants from Fondazione IRCCS Ca’ Granda (affiliations 1 and 2), research support was provided by grants from the Italian Ministry of Health and Lumbardy's Regional Government Authority (Ministero della Salute e Regione Lombardia call no. 2011-02348234).

    If you would like to chat with an author of this article, you may contact Dr Elli at [email protected].

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