Video capsule endoscopy and double-balloon enteroscopy play an important role in the evaluation of selected patients with celiac disease, particularly in complex, non-responsive, or refractory cases. While conventional upper gastrointestinal endoscopy remains essential for diagnosis, it does not allow complete assessment of the small bowel. Video capsule endoscopy offers a non-invasive, patient-friendly method to visualize the entire small intestine and identify mucosal abnormalities such as villous atrophy, scalloping, mosaic pattern, ulcerations, strictures, bleeding, or lesions suggestive of complications, including refractory celiac disease, ulcerative jejunoileitis, and enteropathy-associated T-cell lymphoma.
Double-balloon enteroscopy complements capsule endoscopy by providing direct endoscopic access to deep small-bowel segments. It allows targeted biopsies, histological confirmation, tattooing of suspicious areas, and therapeutic procedures when required. This combined approach is especially useful when capsule endoscopy detects abnormalities that need further characterization or tissue diagnosis.
Artificial intelligence is increasingly enhancing the value of small-bowel endoscopy in celiac disease. AI-based systems may support automated detection of villous atrophy, ulcerations, bleeding, and subtle mucosal changes, reducing reading time and improving diagnostic consistency. In the future, integration of AI with capsule endoscopy and device-assisted enteroscopy could help stratify risk, identify early complications, and guide personalized follow-up strategies.
Together, video capsule endoscopy, double-balloon enteroscopy, and artificial intelligence represent a powerful and evolving diagnostic pathway for improving the management of patients with complicated celiac disease.