Can Video Capsule Endoscopy Replace Biopsy in the Diagnosis of Celiac Disease?

Celiac disease (CD) is diagnosed by demonstrating gluten-induced villous atrophy on duodenal biopsy in patients with positive serology. Duodenal histology remains the gold standard, although pediatric guidelines allow a no-biopsy approach in highly seropositive children. Video capsule endoscopy (VCE) can visualize mucosal changes typical of active CD, such as flattening of mucosal folds, fissuring, scalloping, ulcerations, throughout the small bowel, overcoming the regular endoscopy capability of reaching the proximal duodenum and missing distal and patchy lesions. In this review, I discussed whether VCE can replace duodenal biopsy for diagnosing celiac disease. I summarized diagnostic yield, sensitivity/specificity, and clinical contexts favoring VCE as well as its limitations and potential future role (including artificial intelligence enhancement). I found that video capsule endoscopy is a valuable adjunctive tool to diagnose CD, but currently it complements, rather than outright replaces, duodenal biopsy.