Endocytoscopy for the detection of microstructural features in adult patients with celiac sprue: a prospective, blinded endocytoscopy-conventional histology correlation study - 23/08/11
Reprint requests: Daniel C. Baumgart, MD, PhD, Department of Medicine, Division of Gastroenterology and Hepatology, Charité Medical Center–Virchow Hospital, Medical School of the Humboldt-University, Augustenburger Platz 1, D-13353 Berlin, Germany.Berlin, Hamburg, Germany, White River Junction, Vermont, Lebanon, New Hampshire, USA
Abstract |
Background |
Endocytoscopy (EC) is a novel technique that allows magnified live inspection of the intestinal mucosa.
Objective |
To evaluate EC for the detection of key pathological findings in patients with celiac sprue.
Design |
A total of 166 EC recordings were prospectively acquired. Matched videos, images, and biopsy specimens were obtained by duodenal argon beamer labeling of the respective sites.
Setting |
Academic tertiary referral center.
Patients |
Forty patients (mean age 51.5 years, 70% women) with established (n = 32) or suspected (n = 8) celiac disease (CD).
Interventions |
A validated scoring system (Marsh classification) was used to assess disease activity. EC criteria were independently evaluated by 2 gastroenterologists and 1 pathologist.
Main Outcome Measurements |
The primary endpoint was to examine EC correlation with conventional CD histology.
Results |
Of 166 duodenal biopsy sites, 23% were classified as Marsh III (moderate to severe), 10% as Marsh I (mild), and 67% as Marsh 0 (normal). Using the 450× magnification, we found that identification of crypts was diagnostic for celiac pathology. Four criteria were significant predictors of Marsh III pathology when adjusted by multivariate analysis: low number of villi per visual field (<3; odds ratio [OR] 9.1; 95% CI, 1.3-62.0), confluence of villi (OR 37.1; 95% CI, 1.3-1021.2), irregular epithelial lining (OR 10.9; 95% CI, 2.5-46.7), and inability to delineate loop capillaries (OR 14.9; 95% CI, 3.3-67.0). None was a good predictor of Marsh I pathology.
Limitations |
Single-center experience. No prospective validation of the criteria in an independent patient population.
Conclusions |
EC at 450× magnification accurately identifies mucosal histopathology of advanced CD, but not early morphological changes.
Le texte complet de cet article est disponible en PDF.Abbreviations : CD, CLM, EC, OR
Plan
| DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. |
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| If you would like to chat with an author of this article, you may contact him at daniel.baumgart@charite.de, www.danielbaumgart.de, or www.danielbaumgart.us. |
Vol 70 - N° 5
P. 933-941 - novembre 2009 Retour au numéro
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