Wireless capsule endoscopy is currently considered the gold standard in the investigation of the small bowel. It is both practical for physicians and easily accepted by patients. Prior to its development, two types of imaging investigations of the small bowel were available: radiologic and endoscopic. The first category is less invasive and comfortable for patients; it presents the ensemble of the small bowel, but it may imply radiation exposure. Images are constructed based on signals emitted by various equipment and require special interpretation. Endoscopic techniques provide real-time colored images acquired by miniature cameras from inside the small bowel, require interpretation only from a medical point of view, may allow the possibility to perform biopsies, but the investigation only covers a part of the small bowel and are more difficult to accept by patients. Wireless capsule endoscopy is the current solution that overcomes a part of the previous drawbacks: it covers the entire small bowel, it provides real-time images acquired by cameras, it is painless for patients, and it represents an abundant source of information for physicians. Yet, it lacks motion control and the possibility to perform biopsies or administer drugs. However, significant effort has been oriented in these directions by technical and medical teams, and more advanced capsules will surely be available in the following years.

• Alergia
• Allergy
• Celiac disease
• Diagnosis
• Diagnóstico
• Enfermedad celíaca
• Gluten
• Mexico
• México
• Sensibilidad
• Sensitivity

• Celiac Disease/diagnosis
• Celiac Disease/diet therapy
• Celiac Disease/genetics
• Celiac Disease/therapy
• Diet, Gluten-Free
• Disease Susceptibility
• Humans
• Mexico
• Patient Compliance

• capsule endoscopy
• celiac disease
• gluten
• lymphoma
• non-responsive celiac disease

• Celiac disease
• Celiac sprue
• Enteropathy
• Gluten
• Villous atrophy

To quantify the presence of villous atrophy in endoscopic images for improved automation.

There are two main categories of quantitative descriptors helpful to detect villous atrophy: (1) Statistical and (2) Syntactic. Statistical descriptors measure the small intestinal substrate in endoscope-acquired images based on mathematical methods. Texture is the most commonly used statistical descriptor to quantify villous atrophy. Syntactic descriptors comprise a syntax, or set of rules, for analyzing and parsing the substrate into a set of objects with boundaries. The syntax is designed to identify and distinguish three-dimensional structures based on their shape.

The variance texture statistical descriptor is useful to describe the average variability in image gray level representing villous atrophy, but does not determine the range in variability and the spatial relationships between regions. Improved textural descriptors will incorporate these factors, so that areas with variability gradients and regions that are orientation dependent can be distinguished. The protrusion syntactic descriptor is useful to detect three-dimensional architectural components, but is limited to identifying objects of a certain shape. Improvement in this descriptor will require incorporating flexibility to the prototypical template, so that protrusions of any shape can be detected, measured, and distinguished.

Improved quantitative descriptors of villous atrophy are being developed, which will be useful in detecting subtle, varying patterns of villous atrophy in the small intestinal mucosa of suspected and known celiac disease patients.

• Celiac disease
• Endoscopy
• Small intestine
• Video capsule
• Villous atrophy

• Refractory coeliac disease type II
• autologous stem cell transplantation
• cladribine
• coeliac disease
• complicated coeliac disease
• enteropathy-associated T-cell lymphoma

• Celiac disease
• Enteropathy associated T cell lymphoma
• Refractory celiac disease
• Small bowel adenocarcinoma

• Capsule endoscopy
• Enteroscopy
• Small bowel

AIM: To report the outcome of surgery in patients with (pre)malignant conditions of celiac disease (CD) and the impact on survival.

METHODS: A total of 40 patients with (pre)malignant conditions of CD, ulcerative jejunitis (n = 5) and enteropathy associated T-cell lymphoma (EATL) (n = 35), who underwent surgery between 2002 and 2013 were retrospectively evaluated. Data on indications, operative procedure, post-operative morbidity and mortality, adjuvant therapy and overall survival (OS) were collected. Eleven patients with EATL who underwent chemotherapy without resection were included as a control group for survival analysis. Patients were followed-up every three months during the first year and at 6-mo intervals thereafter.

RESULTS: Mean age at resection was 62 years. The majority of patients (63%) underwent elective laparotomy. Functional stenosis (n = 13) and perforation (n = 12) were the major indications for surgery. In 70% of patients radical resection was performed. Early postoperative complications, mainly due to leakage or sepsis, occurred in 14/40 (35%) of patients. Eight patients required reoperation. More patients who underwent resection in the acute setting (n = 3, 20%) died compared to patients treated in the elective setting. With a median follow-up of 20 mo, seven patients (18%) required reoperation due to long-term complications. Significantly more patients who underwent acute surgery could not be treated with adjuvant chemotherapy. Patients who first underwent surgical resection showed significantly better OS than patients who received chemotherapy without resection.

CONCLUSION: Although the complication rate is high, the preferred first step of treatment in (pre)malignant CD consists of local resection as early as possible to improve survival.

• Enteropathy associated T-cell lymphoma
• Ulcerative jejunitis
• Refractory celiac disease
• Celiac disease

• Aged
• Antineoplastic Agents/therapeutic use
• Celiac Disease/diagnosis
• Celiac Disease/drug therapy
• Celiac Disease/mortality
• Celiac Disease/surgery
• Chemotherapy, Adjuvant
• Digestive System Surgical Procedures/adverse effects
• Digestive System Surgical Procedures/mortality
• Elective Surgical Procedures
• Enteropathy-Associated T-Cell Lymphoma/diagnosis
• Enteropathy-Associated T-Cell Lymphoma/drug therapy
• Enteropathy-Associated T-Cell Lymphoma/mortality
• Enteropathy-Associated T-Cell Lymphoma/surgery
• Female
• Humans
• Intestinal Neoplasms/diagnosis
• Intestinal Neoplasms/drug therapy
• Intestinal Neoplasms/mortality
• Intestinal Neoplasms/surgery
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Netherlands
• Postoperative Complications/etiology
• Precancerous Conditions/diagnosis
• Precancerous Conditions/drug therapy
• Precancerous Conditions/mortality
• Precancerous Conditions/surgery
• Retrospective Studies
• Risk Factors
• Time Factors
• Treatment Outcome

• Celiac Disease/complications
• Celiac Disease/diagnostic imaging
• Diagnostic Imaging
• Humans
• Intestine, Small/diagnostic imaging
• Radiography

• Capsule Endoscopy
• Celiac Disease/diagnosis
• Duodenum/pathology
• Follow-Up Studies
• Humans
• Microvilli/pathology
• Time Factors

• Celiac disease
• Enteroscopy
• Malignancies
• Small bowel

A small subset of coeliac disease (CD) patients experiences persisting or recurring symptoms despite strict adherence to a gluten-free diet (GFD). When other causes of villous atrophy have been excluded, these patients are referred to as refractory celiac disease (RCD) patients. RCD can be divided in two types based on the absence (type I) or presence (type II) of an, usually clonal, intraepithelial lymphocyte population with aberrant phenotype. RCDI usually runs a benign course and may be difficult to be differentiated from uncomplicated, slow responding CD. In contrast, RCDII can be defined as low-grade intraepithelial lymphoma and frequently transforms into an aggressive enteropathy associated T-cell lymphoma with dismal prognosis. This paper describes the clinical characteristics of RCDI and RCDII, diagnostic approach, and the latest insights in treatment options.