Optical Coherence Tomography to Identify Villous Morphology in Patients with Suspected Celiac Disease

Abstract

Introduction: The prevalence of celiac disease (CD) is currently increased compared to our experience in the past. Serological findings are very useful in increasing our screening capacity, but histology remains the gold standard in the diagnosis of CD. OCT is a new imaging technique, similar to B-mode ultrasound (US), but its resolution is far greater (5-10 ìm) near to histology. No data are actually available on the use of OCT in the small intestine and, in particular, in the diagnosis of CD. Aim & Methods: Aim of our study is to test the utility of OCT in patients with serological positivity to antigliadine and antiendomisial antibodies undergone to esofago-gastro-duodenoscopy (EGDS) for histological diagnosis. We enrolled 5 patients with suspected CD and 5 normal subjects who underwent EGDS for dyspepsia. OCT scanning of descending duodenum was performed during diagnostic EGDS and biopsies of the same area of the duodenum were taken. Evaluation of OCT images and histological specimens was blind, the analysis being performed independently by a gastroenterologist and a pathologist. Three patterns of intestinal villous morphology were considered (1 = no atrophy; 2 = mild atrophy; 3 = total atrophy). Results: We obtained the same results about villous pattern into the two group with the two techniques, and similar data about mean villous height in celiac group (0.25 mm in the OCT measures vs 0.28 mm in the histological measures) but with an increased value in the data performed by OCT into the normal subjects group (mean villous height: 0.70 mm vs 0.40 mm). Conclusions: There is a good concordance between histology and OCT to identify villous pattern of CD. However measurements of intestinal villous height show an increased value in OCT, particularly in control patients, possibly due to the villous rhitidosis after histological handling. OCT appears to be a promising technique to identify CD during endoscopy. An unsolved problem remains the impossibility to detect, at present, lymphocitic infiltrate and crypt's hypertrophy, two specific tools in the diagnosis of CD. Our preliminary data must be confirmed by further studies. Introduction: The prevalence of celiac disease (CD) is currently increased compared to our experience in the past. Serological findings are very useful in increasing our screening capacity, but histology remains the gold standard in the diagnosis of CD. OCT is a new imaging technique, similar to B-mode ultrasound (US), but its resolution is far greater (5-10 ìm) near to histology. No data are actually available on the use of OCT in the small intestine and, in particular, in the diagnosis of CD. Aim & Methods: Aim of our study is to test the utility of OCT in patients with serological positivity to antigliadine and antiendomisial antibodies undergone to esofago-gastro-duodenoscopy (EGDS) for histological diagnosis. We enrolled 5 patients with suspected CD and 5 normal subjects who underwent EGDS for dyspepsia. OCT scanning of descending duodenum was performed during diagnostic EGDS and biopsies of the same area of the duodenum were taken. Evaluation of OCT images and histological specimens was blind, the analysis being performed independently by a gastroenterologist and a pathologist. Three patterns of intestinal villous morphology were considered (1 = no atrophy; 2 = mild atrophy; 3 = total atrophy). Results: We obtained the same results about villous pattern into the two group with the two techniques, and similar data about mean villous height in celiac group (0.25 mm in the OCT measures vs 0.28 mm in the histological measures) but with an increased value in the data performed by OCT into the normal subjects group (mean villous height: 0.70 mm vs 0.40 mm). Conclusions: There is a good concordance between histology and OCT to identify villous pattern of CD. However measurements of intestinal villous height show an increased value in OCT, particularly in control patients, possibly due to the villous rhitidosis after histological handling. OCT appears to be a promising technique to identify CD during endoscopy. An unsolved problem remains the impossibility to detect, at present, lymphocitic infiltrate and crypt's hypertrophy, two specific tools in the diagnosis of CD. Our preliminary data must be confirmed by further studies.