Detection of Villous Atrophy Using Endoscopic Images for the Diagnosis of Celiac Disease

Abstract

The most common cause of villous atrophy is celiac disease. The current ‘‘gold standard’’ in the diagnosis of celiac disease is the demonstration of villous atrophy in duodenal biopsies, which are usually obtained during a fiber-optic endoscopic foregut examination [1]. Since conventional upper tract endoscopy does not extend past the duodenum, it is not suitable to determine the length of pathological involvement of the small intestine. Moreover, since duodenal villous atrophy is often patchy [2, 3], gross mucosal features, such as scalloping of duodenal folds, reduction of duodenal folds, mosaic pattern (cobblestone appearance of the mucosal surface), and mucosal fissuring [4–7], can be used to identify involved areas. It is nevertheless possible to miss the involved areas since the gross manifestations of villous atrophy may be absent in mild disease [8, 9].