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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Article Info
Publication History
Accepted:
February 9,
2007
Received:
October 10,
2006
Boston, Massachusetts, USA, Caracas, VenezuelaIdentification
Copyright
© 2007 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
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- Novel endoscopic methods for the evaluation of the small-bowel mucosaGastrointestinal EndoscopyVol. 66Issue 2
- PreviewStandard 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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