Double Balloon Endoscopy in Celiac Disease

In patients with celiac disease (CD), double balloon endoscopy (DBE) allows evaluation of endoscopic signs of celiac disease in the small bowel distal to the duodenum and enables obtaining biopsy specimens. DBE in CD is indicated especially in patients: (1) who are over 50 years old at age of diagnosis and fail to respond on a gluten-free diet (GFD) and findings of gastroduodenoscopy offer no explanation; (2) who previously responded on a GFD but are experiencing weight loss, abdominal pain, diarrhea, or anemia and findings of gastroduodenoscopy offer no explanation; (3) with a history or clinical findings suggestive of small bowel stenosis; (4) in whom radiological findings are suggestive of small bowel malignancy; and (5) in whom video capsule endoscopy revealed lesions suggestive of ulcerative jejunitis, enteropathy associated T-cell lymphoma, or small bowel adenocarcinoma. DBE allows endoscopical visualization of CD-related morphological abnormalities of the small bowel mucosa, obtaining biopsy specimens, and the marking of lesions for surgical resection.