Diagnostic Yield of Video Capsule Endoscopy (VCE) in Celiac Disease (CD): A Systematic Review and Meta-analysis

Background: Celiac disease is an immune-mediated disorder triggered by the ingestion of gluten in genetically susceptible individuals. CD mainly involves the proximal small intestine and has diverse clinical features ranging from severe gastrointestinal symptoms to no symptoms. Diagnosis is based on CD-specific serology and small bowel biopsy. Video capsule endocopy (VCE) is a relatively safe method that provides high-resolution imaging of the entire small intestine mucosa. Today, VCE assists in CD diagnosis in many circumstances. Methods: We systematically searched the medical literature databases up to December 31, 2023, for English-language studies on CD diagnosis by the VCE. Our inclusion criteria comprised complete articles with extractable data and focused on the VCE yield of known celiac patients. Following data extraction, a Meta-Analysis was performed using Comprehensive Meta-Analysis Software (version 4; Biostat Inc., Englewood, NJ). Results: We found 22 studies and 46 substudies published up to 31.12.2023 of VCE performed in CD and met our inclusion criteria. Together 1585 patients were studied, of whom 1253 (79.05%) were women. The average age of the patients was 51.94±9.98 SD. A complete small bowel investigation was achieved in 1533 (96.72%) of the patients. Any diagnostic pathology's effect size (ES) was 0.601, 95% CI: 0.518-0.678. Specific findings of villous atrophy, scalloping, mosaic pattern, fissuring, ulcers, or erosions were demonstrated with ES of 0.604, 0.571, 0.440, 0.445, and 0.252 of the cases, and as expected higher in refractory celiac disease. Conclusions: Our findings demonstrate pathognomonic features and supported CE diagnosis in about 60% of the patients.