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.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gastrointestinal EndoscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The clinical pattern of subclinical/silent celiac disease: an analysis on 1026 consecutive cases.Am J Gastroenterol. 1999; 94: 691-696
- The endoscopic appearance of duodenal folds is predictive of untreated adult celiac disease.Gastrointest Endosc. 1992; 38: 148-151
- Endoscopic demonstration of loss of duodenal folds in the diagnosis of celiac disease.N Engl J Med. 1988; 319: 741-744
- Scalloped valvulae conniventes: an endoscopic marker of celiac sprue.Gastroenterology. 1988; 95: 1518-1522
- The endoscopic demonstration of coeliac disease.Endoscopy. 1976; 8: 177-180
- 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
- Reevaluation of duodenal endoscopic markers in the diagnosis of celiac disease.Gastrointest Endosc. 2000; 51: 714-716
- Value of endoscopic markers in celiac disease.Dig Dis Sci. 1993; 38: 2028-2033
- Endoscopic features of celiac disease in adults and their correlation with age, histological damage, and clinical form of the disease.Endoscopy. 2002; 34: 787-792
- Disappointing sensitivity of endoscopic markers for villous atrophy in a high-risk population: implications for celiac disease diagnosis during routine endoscopy.Am J Gastroenterol. 2001; 96: 2126-2128
- Comparison of suction capsule and endoscopic biopsy of small bowel mucosa.Gastrointest Endosc. 1986; 32: 278-281
- Prevalence of celiac disease and its endoscopic markers among patients having routine upper gastrointestinal endoscopy.Am J Gastroenterol. 1999; 94: 2182-2186
- High accuracy and cost-effectiveness of a biopsy-avoiding endoscopic approach in diagnosing coeliac disease.Aliment Pharmacol Ther. 2006; 23: 61-69
- Value of chromoendoscopy and magnification endoscopy in the evaluation of duodenal abnormalities: a prospective, randomized comparison.Endoscopy. 2003; 35: 559-563
- How good is zoom endoscopy for assessment of villous atrophy in coeliac disease?.Endoscopy. 2005; 37: 994-998
- Combined magnification endoscopy with chromoendoscopy in the evaluation of patients with suspected malabsorption.Gastrointest Endosc. 1997; 46: 226-230
- Acetic acid improves identification of remnant islands of Barrett's epithelium after endoscopic therapy.Gastrointest Endosc. 1998; 47: 512-515
- Enhanced magnification endoscopy: a new technique to identify specialized intestinal metaplasia in Barrett's esophagus.Gastrointest Endosc. 2001; 53: 559-565
- Detection of intestinal metaplasia in distal esophagus and esophagogastric junction by enhanced-magnification endoscopy.Gastrointest Endosc. 2004; 59: 15-21
- Intestinal metaplasia of the gastric cardia: a prospective study with enhanced magnification endoscopy.Am J Gastroenterol. 2002; 97: 584-589
- Magnification and chromoscopy with the acetic acid test.Endoscopy. 2003; 35: 437-445
- The insensitivity of endoscopic markers in celiac disease.Am J Gastroenterol. 2002; 97: 933-938
- Evaluation of sensitivity and inter- and intra-observer variability in the detection of intestinal metaplasia and dysplasia in Barrett's esophagus with enhanced magnification endoscopy.Scand J Gastroenterol. 2006; 41: 349-356
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.
ScienceDirect
Access this article on ScienceDirectLinked Article
- 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.
- Full-Text
- Preview