Narrow band imaging with magnification endoscopy for celiac disease: results from a prospective, single-center study

L De Luca, L Ricciardiello, M B L Rocchi, M T Fabi, M L Bianchi, A de Leone, S Fiori, D Baroncini, L De Luca, L Ricciardiello, M B L Rocchi, M T Fabi, M L Bianchi, A de Leone, S Fiori, D Baroncini

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.

Figures

Figure 1
Figure 1
(a, b, and c) Normal villous patterns. Visualization of normal duodenal mucosa at white light SE (a). Regular villi appear well represented, thick, with a finger-like appearance at NBI system and ME (b and c). (d, e, and f) Abnormal villous patterns. Partial villous atrophy view at SE (d); NBI-ME showing a low-density of villi which appear irregular, disoriented, and with an initial pattern of surface destruction (e and f). (g, h, and i) Absent villous patterns. Marked villous atrophy with NBI system and ME (g); the surface is flat (h), “foveolar-like,” with total villi absence and wide circles (i: black arrow).
Figure 2
Figure 2
Receiver operating characteristic curves of NBI-ME and SE for diagnosing CD.

References

    1. Dickey W, Hughes D. Prevalence of celiac disease and its endoscopic markers among patients having routine upper gastrointestinal endoscopy. American Journal of Gastroenterology. 1999;94(8):2182–2186.
    1. Dickey W, Hughes D. Disappointing sensitivity of endoscopic markers for villous atrophy in a high-risk population: implications for celiac disease diagnosis during routine endoscopy. American Journal of Gastroenterology. 2001;96(7):2126–2128.
    1. Lecleire S, Di Fiore F, Antoniette M, et al. Endoscopic markers of villous atrophy are not useful for the detection of celiac disease in patients with dyspeptic symptoms. Endoscopy. 2006;38(7):696–701.
    1. Dickey W. Endoscopic markers for celiac disease. Nature Clinical Practice Gastroenterology & Hepatology. 2006;3(10):546–551.
    1. Bardella MT, Minoli G, Radaelli F, Quatrini M, Blanchi PA, Conte D. Reevaluation of duodenal endoscopic markers in the diagnosis of celiac disease. Gastrointestinal Endoscopy. 2000;51(6):714–715.
    1. Maurino E, Capizzano H, Niveloni S, et al. Value of endoscopic markers in celiac disease. Digestive Diseases and Sciences. 1993;38(11):2028–2033.
    1. Tursi A, Brandimarte G, Giorgetti GM, Gigliobianco A. Endoscopic features of celiac disease in adults and their correlation with age, histological damage, and clinical form of the disease. Endoscopy. 2002;34(10):787–792.
    1. Lo A, Guelrud M, Essenfeld H, Bonis P. Classification of villous atrophy with enhanced magnification endoscopy in patients with celiac disease and tropical sprue. Gastrointestinal Endoscopy. 2007;66(2):377–382.
    1. Kiesslich R, Mergener K, Naumann C, et al. Value of chromoendoscopy and magnification endoscopy in the evaluation of duodenal abnormalities: a prospective, randomized comparison. Endoscopy. 2003;35(7):559–563.
    1. Badreldin R, Barrett P, Wooff DA, Mansfield J, Yiannakou Y. How good is zoom endoscopy for assessment of villous atrophy in coeliac disease? Endoscopy. 2005;37(10):994–998.
    1. Banerjee R, Shekharan A, Ramji C, et al. Role of magnification endoscopy in the diagnosis and evaluation of suspected celiac disease: correlation with histology. Indian Journal of Gastroenterology. 2007;26(2):67–69.
    1. Cammarota G, Cesaro P, Cazzato A, et al. Optimal band imaging system: a new tool for enhancing the duodenal villous pattern in celiac disease. Gastrointestinal Endoscopy. 2008;68(2):352–357.
    1. Banerjee R, Reddy DN. High-resolution narrow-band imaging can identify patchy atrophy in celiac disease: targeted biopsy can increase diagnostic yield. Gastrointestinal Endoscopy. 2009;69(4):984–985.
    1. Song LM, Adler DG, Conway JD, et al. Narrow band imaging and multiband imaging. Gastrointestinal Endoscopy. 2008;67(4):581–589.
    1. Yao K, Takaki Y, Matsui T, et al. Clinical application of magnification endoscopy and narrow-band imaging in the upper gastrointestinal tract: new imaging techniques for detecting and characterizing gastrointestinal neoplasia. Gastrointestinal Endoscopy Clinics of North America. 2008;18(3):415–433.
    1. Pais WP, Duerksen DR, Pettigrew NM, Bernstein CN. How many duodenal biopsy specimens are required to make a diagnosis of celiac disease? Gastrointestinal Endoscopy. 2008;67(7):1082–1087.
    1. Oberhuber G, Granditsch G, Vogelsang H. The histopathology of coeliac disease: time for a standardized report scheme for pathologists. European Journal of Gastroenterology and Hepatology. 1999;11(10):1185–1194.
    1. Siegel LM, Stevens PD, Lightdale CJ, et al. Combined magnification endoscopy with chromoendoscopy in the evaluation of patients with suspected malabsorption. Gastrointestinal Endoscopy. 1997;46(3):226–230.
    1. Pohl J, May A, Rabenstein T, Pech O, Ell C. Computed virtual chromoendoscopy: a new tool for enhancing tissue surface structures. Endoscopy. 2007;39(1):80–83.
    1. Singh R, Nind G, Tucker G, et al. Narrow-band imaging in the evaluation of villous morphology: a feasibility study assessing a simplified classification and observer agreement. Endoscopy. 2010;42(11):889–894.
    1. Brocchi E, Corazza GR, Caletti G, Treggiari EA, Barbara L, Gasbarrini G. Endoscopic demonstration of loss of duodenal folds in the diagnosis of celiac diasease. The New England Journal of Medicine. 1988;319(12):741–744.
    1. Cammarota G, Fedeli P, Gasbarrini A. Emerging technologies in upper gastrointestinal endoscopy and celiac disease. Nature Clinical Practice Gastroenterology and Hepatology. 2009;6(1):47–56.
    1. Trovato C, Sonzogni A, Ravizza D, et al. Celiac disease: in vivo diagnosis by confocal endomicroscopy. Gastrointestinal Endoscopy. 2007;65(7):1096–1099.
    1. Masci E, Mangiavillano B, Albarello L, Mariani A, Doglioni C, Testoni PA. Pilot study on the correlation of optical coherence tomography with histology in celiac disease and normal subjects. Journal of Gastroenterology and Hepatology. 2007;22(12):2256–2260.
    1. Fedeli P, Gasbarrini G, Cammarota G. The combined application of advanced endoscopic imaging techniques may increase the duodenal villous morphology definition in suspected celiac disease. Digestive and Liver Disease. 2010;42(8):595–596.
    1. Rubio-Tapia A, Murray JA. Novel endoscopic methods for the evaluation of the small-bowel mucosa. Gastrointestinal Endoscopy. 2007;66(2):382–386.
    1. Elli L, Bonura A, Bardella MT. Avoiding duodenal endoscopic biopsies in celiac disease: are we going forward or looking to the past? Digestive and Liver Disease. 2010;42(2):p. 154.
    1. Di Tola M, Sabbatella L, Anania MC, et al. Anti-tissue transglutaminase antibodies in inflammatory bowel disease: new evidence. Clinical Chemistry and Laboratory Medicine. 2004;42(10):1092–1097.
    1. Shah VH, Rotterdam H, Kotler DP, Fasano A, Green PHR. All that scallops is not celiac disease. Gastrointestinal Endoscopy. 2000;51(6):717–720.
    1. Krauss N, Schuppan D. Monitoring nonresponsive patients who have celiac disease. Gastrointestinal Endoscopy Clinics of North America. 2006;16(2):317–327.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir