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Classification of villous atrophy with enhanced magnification endoscopy in patients with celiac disease and tropical sprue

  • Amy Lo
    Affiliations
    Current affiliations: Department of Gastroenterology (A.L., M.G. P.B.), Tufts-New England Medical Center, Boston, Massachusetts, USA, Department of Pathology (H.E.), Policlínica Metropolitana, Caracas, Venezuela
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  • Moises Guelrud
    Correspondence
    Reprint requests: Moises Guelrud, MD, Department of Gastroenterology, Tufts-New England Medical Center, 750 Washington St, Box 233, Boston, MA 02111.
    Affiliations
    Current affiliations: Department of Gastroenterology (A.L., M.G. P.B.), Tufts-New England Medical Center, Boston, Massachusetts, USA, Department of Pathology (H.E.), Policlínica Metropolitana, Caracas, Venezuela
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  • Harold Essenfeld
    Affiliations
    Current affiliations: Department of Gastroenterology (A.L., M.G. P.B.), Tufts-New England Medical Center, Boston, Massachusetts, USA, Department of Pathology (H.E.), Policlínica Metropolitana, Caracas, Venezuela
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  • Peter Bonis
    Affiliations
    Current affiliations: Department of Gastroenterology (A.L., M.G. P.B.), Tufts-New England Medical Center, Boston, Massachusetts, USA, Department of Pathology (H.E.), Policlínica Metropolitana, Caracas, Venezuela
    Search for articles by this author

      Background

      Intestinal lesions in celiac disease (CD) and tropical sprue (TS) can be patchy. Improved endoscopic identification of affected areas may increase the diagnostic yield of biopsy specimens. Enhanced magnification endoscopy [EME] combines magnification endoscopy with 3% acetic acid instillation.

      Objective

      This study describes endoscopic findings associated with villous atrophy during EME.

      Design

      Patients underwent EME with a magnifying endoscope with acetic-acid application. Surface mucosal patterns were characterized before and after acetic-acid spraying. Observed surface patterns were compared with histologic results obtained from a single targeted biopsy specimen.

      Setting

      Policlinica Metropolitana in Caracas, Venezuela.

      Patients

      Patients with diagnosed but untreated CD or TS.

      Results

      Fifty-two biopsy specimens were obtained from 27 patients (17 men, 10 women; mean age 50.5 years; range, 24-76 years; 12 with CD and 15 with TS). EME of the duodenum revealed 4 different mucosal patterns: I, normal; II, stubbed; III, ridged; and IV, foveolar. Three of the 4 patterns were strongly associated with the presence of villous atrophy (pattern I, 1/18 [5.5%]; II, 16/17 [94%]; III, 12/12 [100%]; and IV, 5/5 [100%]). EME was more sensitive than standard endoscopy for detecting villous atrophy, 100% versus 58% in CD and 93% versus 20% in TS. Furthermore, EME identified patchy areas of partial villous atrophy in 16 patients (5 CD and 11 TS) in whom standard endoscopy was normal.

      Conclusions

      EME identifies 3 characteristic endoscopic patterns that correlate with the presence of villous atrophy. EME could help identify patchy areas of partial mucosal atrophy, potentially reducing the need for blind biopsies.
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      Linked Article

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        Gastrointestinal EndoscopyVol. 66Issue 2
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          Standard endoscopy has been a robust method for the detection of macroscopic lesions, such as peptic ulcer disease, strictures, and tumors.1 However, it has become apparent that, in the modern era, there is a necessity for more accurate endoscopic methods for the detection of subtle mucosal abnormalities. Indeed, the lack of an ability to visually detect clinically significant alterations in the intestinal mucosa, make the routine histologic assessment of biopsy specimens indispensable to detect and classify diseases of the small-bowel mucosa.
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