Evidence map›Paper›PMID 41807635›Full record

ArticleEuropean journal of pediatrics2026

Adherence to guidelines, pitfalls, and emerging technologies in endoscopic practice for celiac disease: a nationwide SIGENP survey.

Silvana Ancona, Federica Malerba, Federico Medina, Paolo Gandullia, Andrea Chiaro, Sara Renzo, Paola De Angelis, Claudio Romano, Monica Malamisura, Renata Auricchio and 1 more

Abstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in European journal of pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Silvana AnconaUOC Reumatologia E Malattie Autoinfiammatorie, IRCCS Istituto Giannina Gaslini, 16147, Genoa, Italy.
Federica MalerbaDepartment of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, 16147, Genoa, Italy.
Federico MedinaDivision of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, 28100, Novara, Italy.
Paolo GandulliaPediatric Gastroenterology and Endoscopy Unit, IRCCS Istituto Giannina Gaslini, Largo G. Gaslini 5, 16147, Genoa, Italy.
Andrea ChiaroPediatric Gastroenterology and Endoscopy Unit, IRCCS Istituto Giannina Gaslini, Largo G. Gaslini 5, 16147, Genoa, Italy.
Sara RenzoGastroenterology and Nutrition Unit, Meyer Children's Hospital IRCCS, 50139, Florence, Italy.
Paola De AngelisDigestive Surgery and Endoscopy Unit, IRCCS Bambino Gesù Children's Hospital, 00165, Rome, Italy.
Claudio RomanoPediatric Gastroenterology and Cystic Fibrosis, University of Messina, 98122, Messina, Italy.
Monica MalamisuraDigestive Surgery and Endoscopy Unit, IRCCS Bambino Gesù Children's Hospital, 00165, Rome, Italy.
Renata AuricchioDepartment of Translational Medical Science, Section of Pediatrics, University Federico II, Via Pansini 5, 80131, Naples, Italy.
Marco CroccoPediatric Gastroenterology and Endoscopy Unit, IRCCS Istituto Giannina Gaslini, Largo G. Gaslini 5, 16147, Genoa, Italy. marcocrocco@gaslini.org.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Upper gastrointestinal endoscopy (UGIE) with duodenal biopsies remains the gold standard for diagnosing celiac disease (CD) in children and adolescents. Despite clear guidelines, clinical practices may vary across centers. This self-reported survey study assessed adherence to European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guidelines for pediatric CD in endoscopic practice, focusing on pitfalls and the use of novel technologies. A web-based, multicenter survey was distributed to pediatric gastroenterology centers that are members of the Italian Society of Pediatric Gastroenterology, Hepatology, and Nutrition (SIGENP). Thirty-eight responses from 34 SIGENP centers were analyzed. Overall, 31/34 (91%) respondents reported taking ≥ 5 duodenal biopsies for suspected CD, all including samples from both the duodenal bulb and distal duodenum. However, 9/31 (29%) endoscopists reported not correctly orienting the biopsy specimens. Among patients with persistently elevated anti-transglutaminase IgA (TGA-IgA) despite adherence to a gluten-free diet (GFD), 16 of 33 respondents (48%) performed a second UGIE at a time point other than the recommended 2 years after GFD initiation. Only 8/36 (22%) reported using novel endoscopic technologies, and 10/37 (27%) occasionally employed wireless capsule endoscopy. Artificial intelligence had not yet been incorporated into clinical practice.

conclusionsThis study demonstrates overall compliance with ESPGHAN guidelines, although gaps persist in biopsy orientation and follow-up timing for patients with persistent TGA-IgA positivity. The use of novel endoscopic technologies is still limited, indicating the need for further studies and dedicated training programs to support their implementation in clinical practice. WHAT IS KNOWN: • Diagnostic pitfalls in celiac disease remain a major challenge in endoscopy practice. • New endoscopic tools proved to be useful to decrease the number of misdiagnoses and related healthcare costs of celiac disease. WHAT IS NEW: • Major gaps remain regarding proper orientation of biopsies, and the timing of follow-up endoscopy in patients with persistent TGA-IgA positivity. • Further studies and dedicated training programs are required to facilitate the effective integration of advanced endoscopic technologies into the diagnostic workflow.

Indexed as

Celiac DiseaseEndoscopy, GastrointestinalGuideline AdherencePractice Patterns, Physicians'AdolescentBiopsyChildDiet, Gluten-FreeDuodenumGastroenterologyHumansItalyPractice Guidelines as TopicSurveys and QuestionnairesCeliac diseaseEndoscopyGuidelineVillous atrophy

Identifiers

PMID41807635

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.