Background
Chromo-zoom endoscopy has been demonstrated to be valuable in assessing the degree
of intestinal villous atrophy in patients with suspected celiac disease.
Objective
To evaluate the diagnostic accuracy of chromo-zoom endoscopy in patients with difficult
diagnosis because of nonconcordant test results and/or the confounding of a gluten-free
diet initiated before an appropriate diagnosis of celiac disease and to compare the
findings to a recent reference standard, the in vitro gliadin challenge test.
Design
Prospective, case-control study.
Setting
Tertiary-care referral hospital.
Patients
Patients without celiac disease (negative control group, n = 9), patients with celiac
disease (positive control group, n = 41), and patients with difficult diagnosis (n
= 27).
Intervention
Chromo-endoscopy with indigo carmine and endoscopic zoom-magnification were performed.
Duodenal fragments were collected for the in vitro gliadin challenge test. The area
under the receiver operating characteristic curve (ROC) was used for statistical analyses
on accuracy.
Main Outcome Measurements
Diagnostic accuracy of chromo-zoom endoscopy for detection of mucosal abnormalities
in patients with difficult diagnosis.
Results
Chromo-zoom endoscopy had a high accuracy for celiac disease diagnosis in analyses
on negative controls and positive controls (area under roc = 0.99). In the difficult
diagnosis group, the accuracy of chromo-zoom endoscopy was lower (area under roc =
0.83), but it increased after exclusion of patients with celiac disease on gluten-free
diet (area under roc = 0.88).
Limitations
There was a 4% failure rate in the ability to cultivate biopsies. Also, the study
was done at an academic medical center.
Conclusion
Chromo-zoom endoscopy has high accuracy for cases of difficult diagnosis of celiac
disease but only in untreated patients with celiac disease.
Abbreviations:
a-tTG (anti-tissue transglutaminase antibodies), CD (celiac disease), EMA (endomysial antibody), GFD (gluten-free diet), HLA (human leukocyte antigen), IgG (immunoglobulin G), ROC (receiver operating characteristic curve)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 03, 2012
Accepted:
September 26,
2012
Received:
June 6,
2012
Footnotes
If you would like to chat with an author of this article, you may contact Dr Iovino at [email protected]
DISCLOSURE: The following authors disclosed a financial relationship: Drs Russo and Ciacci received support for this study from the Italian Research Program (PRIN 2006) and by Regione Campania, Assessorato Sanità. None of the funders had any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. No other financial relationships relevant to this publication were disclosed.
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© 2013 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
