Abstract
In celiac disease (CD), the intestinal lesions can be patchy and partial villous atrophy may elude detection at standard endoscopy (SE). Narrow Band Imaging (NBI) system in combination with a magnifying endoscope (ME) is a simple tool able to obtain targeted biopsy specimens. The aim of the study was to assess the correlation between NBI-ME and histology in CD diagnosis and to compare diagnostic accuracy between NBI-ME and SE in detecting villous abnormalities in CD. Forty-four consecutive patients with suspected CD undergoing upper gastrointestinal endoscopy have been prospectively evaluated. Utilizing both SE and NBI-ME, observed surface patterns were compared with histological results obtained from biopsy specimens using the k-Cohen agreement coefficient. NBI-ME identified partial villous atrophy in 12 patients in whom SE was normal, with sensitivity, specificity, and accuracy of 100%, 92.6%, and 95%, respectively. The overall agreement between NBI-ME and histology was significantly higher when compared with SE and histology (kappa score: 0.90 versus 0.46; P = 0.001) in diagnosing CD. NBI-ME could help identify partial mucosal atrophy in the routine endoscopic practice, potentially reducing the need for blind biopsies. NBI-ME was superior to SE and can reliably predict in vivo the villous changes of CD.
Highlights
Standard endoscopy (SE) does not usually allow the visualization of duodenal villous patterns and may be inaccurate in patients with celiac disease (CD) [1,2,3,4]
The overall agreement between Narrow Band Imaging (NBI)-magnifying endoscope (ME) and histology was significantly higher when compared with standard endoscopy (SE) and histology in diagnosing CD
After switching to NBI-ME, a diagnosis of mucosal abnormalities was made in 19 patients
Summary
Standard endoscopy (SE) does not usually allow the visualization of duodenal villous patterns and may be inaccurate in patients with celiac disease (CD) [1,2,3,4]. At SE, partial villous atrophy may elude detection, and a normal endoscopic appearance of the mucosa does not necessarily imply normal histology. Several endoscopic features observed during SE reflect the presence of villous atrophy; their sensitivity varies from 50% to 94% [5, 6]. Sensitivity is low in patients with subclinical CD, partial villous atrophy, or patchy disease [1, 2, 7]. Improved visual identification of suspected mucosal atrophy could assist in targeting biopsies and thereby increasing the sensitivity of endoscopy [8]. Different emerging techniques have been evaluated, alone or in combination, to enhance the ability of the endoscopist to detect mucosal abnormalities, including chromoendoscopy, waterimmersion techniques, magnification endoscopy (ME), alone or combined with acetic-acid instillation, and optimal band imaging [8,9,10,11,12]
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