Oral Presentation International Celiac Disease Symposium 2026

THE ROLE OF CAPSULE ENDOSCOPY IN COELIAC DISEASE IN THE ERA OF NO-BIOPSY APPROACH (147066)

Cristina Caranfil 1 2 3 , Nicoletta Nandi 3 , Christian Bentley 3 , Victoria Thurston 3 , Ailish Healy 3 , Stefania Chetcuti Zammit 4 , Mohammed G. Shiha 5 , Foong Way David Tai 3 , Reena Sidhu 3 5 , Fabiana Zingone 1 2 , David S. Sanders 3 5
  1. Department of Surgery, Oncology and Gastroenterology, University of Padua, Italy, Padua
  2. Unit of Gastroenterology, Azienda Ospedale Università Padova, Padua, , Padua
  3. Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, United Kingdom, Sheffield
  4. Division of Gastroenterology, Mater Dei Hospital, Msida, Malta, Malta
  5. Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK, Sheffield

BACKGROUND: Capsule endoscopy (CE) may complement oesophagostroduodenoscopy (OGD) in the era of no-biopsy approach in challenging cases of coeliac disease (CeD). Recent evidence reported ~60% yield for detecting villous atrophy.

AIM AND METHODS: This dual-centre retrospective study included patients undergoing CE at Sheffield Royal Hallamshire Teaching Hospital between 2017 and February 17, 2026, and the Azienda Ospedale Università di Padova (2019-2022, 2024-May 2026) with OGD or enteroscopy within one year.  Villous atrophy was assessed by CE features including scalloping, mosaic pattern, reduction of folds and granular mucosa. The primary aim was to assess the diagnostic yield (DY) for VA confirmed at duodenal histology. p <0.05 was considered statistically significant.

RESULTS: A total of 250 procedures were included in the final analysis (64.88% females, mean age 52.4 years ± 16.2 SD). The overall DY of CE was 80.0%, with a sensitivity of 92.0% (95% CI: 86.4-95.8%) and a specificity of 38.0% (95% CI; 28.5-48.3%). The PPV was 69.0% (95% CI: 62.1-75.3%), while the NPV was 76.0% (95% CI; 61.8-86.9%). p<0.05, respectively. The sensitivity and specificity of OGD and enteroscopy was 57.3% (95% CI: 49.0-65.4%) and 61.0% (95% CI: 50.7%-70.6%) respectively. The PPV was 68.8% (95% CI: 59.9-76.8%), while the NPV was 48.8% (95% CI: 39.8%-57.9%). The agreement between histology and CE was higher compared to OGD (70.4% vs 58.8%). At a multivariate logistic regression analysis capsule confirmed a higher predictive value when compared to OGD (OR 6.4 vs 1.7, p<0.05).

CONCLUSIONS: Endoscopic features of villous atrophy are strongly predictive of histological confirmation. CE shows high sensitivity for detecting villous atrophy, although specificity remains limited (38.0%). To our knowledge, this is the largest study to date assessing the role of CE in this setting.