Download PDF
Endosc Int Open 2016; 04(05): 540-546
DOI: 10.1055/s-0042-105955
Original article
© Georg Thieme Verlag KG Stuttgart · New York

High definition i-SCAN endoscopy with water immersion technique accurately reflects histological severity of celiac disease

Marietta Iacucci
1   Gastroenterology, University of Calgary, Calgary, AB, Canada
,
Tiffany Poon
1   Gastroenterology, University of Calgary, Calgary, AB, Canada
,
X. Sean Gui
2   Pathology, University of Calgary, Calgary, AB, Canada
,
Subrata Ghosh
1   Gastroenterology, University of Calgary, Calgary, AB, Canada
› Author Affiliations
Further Information

Publication History

submitted 07 September 2015

accepted after revision 07 March 2016

Publication Date:
10 May 2016 (online)

Also available at
   Permissions and Reprints

Background and aims: Severe villous atrophy can be revealed with conventional white light endoscopy (WLE), however, milder grades or patchy villous atrophy are more difficult to detect. Novel endoscopic techniques such as high definition i-SCAN endoscopy with the water immersion technique (i-SCAN-HDWI) may provide the ability to visualize duodenal villi more accurately. We aimed to determine the performance of i-SCAN-HDWI in evaluating the severity of histological damage in the duodenum of patients with celiac disease.

Patients and methods: A retrospective cohort study was performed in a single tertiary academic endoscopic center. We studied 58 patients (46 women; median age 36.5 years, range 18 – 72 years) with positive anti-TTG IgA antibody. The villous pattern of the second part of the duodenum was assessed by WLE and i-SCAN-HDWI. The endoscopic grades in both techniques were correlated using Marsh histologic grades by Spearman correlation coefficient. The diagnostic accuracy of i-SCAN-HDWI for detection of patchy or complete atrophy of the villi was evaluated.

Results: A significant correlation was demonstrated between endoscopic grade using i-SCAN-HDWI and Marsh histologic grade (r = 0.732; P < 0.00001). The correlation between WLE grade and Marsh histologic grade was inferior to i-SCAN-HDWI (r = 0.31; P = 0.01). The sensitivity of i-SCAN-HDWI was 96 % (95 %CI: 85 – 99 %) and the specificity was 63 % (95 %CI: 26 – 90 %) in diagnosing abnormal biopsy consistent with celiac disease.

Conclusion: i-SCAN-HDWI endoscopy can reflect the histological severity of celiac disease more accurately than conventional WLE alone. This novel endoscopic imaging can improve the diagnostic yield of duodenal biopsies in celiac patients, especially for those with a patchy distribution of villous damage.

 

  • References

  • 1 Green PH, Cellier C. Celiac disease. New Engl J Med 2007; 357: 1731-1743
    CrossrefPubMedGoogle Scholar
  • 2 Di Sabatino A, Corazza GR. Coeliac disease. Lancet 2009; 373: 1480-1493
    CrossrefPubMedGoogle Scholar
  • 3 Rubio-Tapia A, Hill ID, Kelly CP et al. ACG clinical guidelines: diagnosis and management of celiac disease. Am J Gastroenterol 2013; 108: 656-667
    CrossrefPubMedGoogle Scholar
  • 4 Ravelli A, Villanacci V, Monfredini C et al. How patchy is patchy villous atrophy? distribution pattern of histological lesions in the duodenum of children with celiac disease. Am J Gastroenterol 2013; 105: 2103-2110
    PubMedGoogle Scholar
  • 5 Bonamico M, Mariani P, Thanasi E et al. Patchy villous atrophy of the duodenum in childhood celiac disease. J Pediatr Gastroenterol Nutr 2004; 38: 204-207
    CrossrefPubMedGoogle Scholar
  • 6 Kurien M, Evans KE, Hopper AD et al. Duodenal bulb biopsies for diagnosing adult celiac disease: is there an optimal biopsy site?. Gastrointest Endosc 2012; 7: 1190-1196
    PubMedGoogle Scholar
  • 7 Hopper AD, Cross SS, Sanders DS et al. Patchy villous atrophy in adult patients with suspected gluten-sensitive enteropathy: is a multiple duodenal biopsy strategy appropriate?. Endoscopy 2008; 40: 219-224
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Maurino E, Capizzano H, Niveloni S et al. Value of endoscopic markers in celiac disease. Dig Dis Sci 1993; 38: 2028-2033
    CrossrefPubMedGoogle Scholar
  • 9 Smith AD, Graham I, Rose JD. A prospective endoscopic study of scalloped folds and grooves in the mucosa of the duodenum as signs of villous atrophy. Gastrointest Endosc 1998; 47: 461-465
    CrossrefPubMedGoogle Scholar
  • 10 Oxentenko AS, Grisolano SW, Murray JA et al. The insensitivity of endoscopic markers in celiac disease. Am J Gastroenterol 2002; 97: 933-938
    CrossrefPubMedGoogle Scholar
  • 11 Maurino E, Bai JC. Endoscopic markers of celiac disease. Am J Gastroenterol 2002; 97: 760-761
    CrossrefPubMedGoogle Scholar
  • 12 Ravelli AM, Tobanelli P, Minelli L et al. Endoscopic features of celiac disease in children. Gastrointest Endosc 2001; 54: 736-742
    CrossrefPubMedGoogle Scholar
  • 13 Barada K, Habib RH, Malli A et al. Prediction of celiac disease at endoscopy. Endoscopy 2014; 46: 110-119
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Oxentenko AS, Murray JA. Celiac disease: ten things that every gastroenterologist should know. Clin Gastroenterol Hepatol 2015; 13: 1396-1404
    CrossrefPubMedGoogle Scholar
  • 15 Rubio-Tapia A, Murray JA. Novel endoscopic methods for the evaluation of the small-bowel mucosa. Gastrointest Endosc 2007; 66: 382-386
    CrossrefPubMedGoogle Scholar
  • 16 Bruno MJ. Magnification endoscopy, high resolution endoscopy, and chromoscopy; towards a better optical diagnosis. Gut 2003; 52: iv7-11
    CrossrefPubMedGoogle Scholar
  • 17 Gasbarrini A, Ojetti V, Cuoco L et al. Lack of endoscopic visualization of intestinal villi with the immersion technique in overt atrophic celiac disease. Gastrointest Endosc 2003; 57: 348-351
    CrossrefPubMedGoogle Scholar
  • 18 Cammarota G, Pirozzi GA, Martino A et al. Reliability of the immersion technique during routine upper endoscopy for detection of abnormalities of duodenal villi in patients with dyspepsia. Gastrointest Endosc 2004; 60: 223-228
    CrossrefPubMedGoogle Scholar
  • 19 Cammarota G, Cazzato A, Genovese O et al. Water-immersion technique during standard upper endoscopy may be useful to drive the biopsy sampling of duodenal mucosa in children with celiac disease. J Pediatr Gastroenterol Nutr 2009; 49: 411-416
    CrossrefPubMedGoogle Scholar
  • 20 Banerjee R, Reddy DN. High-resolution narrow-band imaging can identify patchy atrophy in celiac disease: targeted biopsy can increase diagnostic yield. Gastrointest Endosc 2009; 69: 984-985
    CrossrefPubMedGoogle Scholar
  • 21 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: 889-894
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Valitutti F, Oliva S, Iorfida D et al. Narrow band imaging combined with water immersion technique in the diagnosis of celiac disease. Dig Liver Dis 2014; 46: 1099-1102
    CrossrefPubMedGoogle Scholar
  • 23 Goswami A, Dadhich S, Bhargava N. Use of narrow band imaging in assessing duodenal villous atrophy. Indian J Gastroenterol 2014; 33: 440-444
    CrossrefPubMedGoogle Scholar
  • 24 Fort Gasia M, Gui SX, Poon T et al. Accurate diagnosis of villous atrophy in celiac disease using confocal laser endomicroscopy. Can J Gastroenterol Hepatol 2014; 28: 123-124
    PubMedGoogle Scholar
  • 25 Iovino P, Pascariello A, Russo I et al. Difficult diagnosis of celiac disease: diagnostic accuracy and utility of chromo-zoom endoscopy. Gastrointest Endosc 2013; 77: 233-240
    CrossrefPubMedGoogle Scholar
  • 26 Kodashima S, Fujishiro M. Novel image-enhanced endoscopy with i-scan technology. World J Gastroenterol 2010; 9: 1043-1049
    PubMedGoogle Scholar
  • 27 Cammarota G, Ianiro G, Sparano L et al. Image-enhanced endoscopy with i-scan technology for the evaluation of duodenal villous patterns. Dig Dis Sci 2013; 58: 1287-1292
    CrossrefPubMedGoogle Scholar
  • 28 Oberhuber G, Granditsch G, Vogelsang H. The histopathology of coeliac disease: time for a standardized report scheme for pathologists. Eur J Gastroenterol Hepatol 1999; 11: 1185-1194
    PubMedGoogle Scholar
  • 29 Ciaccio EJ, Tennyson CA, Bhagat G et al. Use of basis images for detection and classification of celiac disease. Biomed Mater Eng 2014; 24: 1913-1923
    PubMedGoogle Scholar
  • 30 Ciaccio EJ, Tennyson CA, Bhagat G et al. Methods to quantitate videocapsule endoscopy images in celiac disease. Biomed Mater Eng 2014; 24: 1895-1911
    PubMedGoogle Scholar