Combined magnification endoscopy with chromoendoscopy in the evaluation of patients with suspected malabsorption.
BACKGROUND
Magnification endoscopy and chromoendoscopy together have been used to evaluate mucosal detail in a number of conditions, including Barrett's esophagus and flat colonic polyps, but they have not been used to evaluate villous atrophy in the proximal small intestine.


METHODS
Thirty-four patients suspected of having a malabsorption syndrome (either celiac disease or tropical sprue) were evaluated using an Olympus magnification gastroscope in both normal and high magnification settings. Indigo carmine dye spraying techniques were used to assist in evaluating duodenal mucosa for evidence of villous atrophy. The accuracy of endoscopically predicted villous atrophy was assessed by histologic evaluation of biopsy specimens taken in the descending duodenum.


RESULTS
Magnification endoscopy with dye spraying was both highly sensitive (94%) and specific (88%) in identifying patients with villous atrophy. This technique was more accurate (91%) in identifying patients with partial atrophy than standard endoscopy (9%, p < 0.01) and was also useful in identifying patients with patchy villous atrophy (5 of 5) to allow directed biopsies of abnormal tissue.


CONCLUSIONS
Magnification endoscopy with chromoendoscopy is a promising technique for the evaluation of patients with suspected malabsorption. This technique is especially valuable in patients with partial atrophy, where villous abnormalities can be patchy and the duodenum usually appears normal during standard endoscopy.
Siegel
L M
LM
Department of Medicine, Columbia-Presbyterian Medical Center, New York, NY 10032, USA.
Stevens
P D
PD
Lightdale
C J
CJ
Green
P H
PH
Goodman
S
S
Garcia-Carrasquillo
R J
RJ
Rotterdam
H
H
D001284:Atrophy; D001471:Barrett Esophagus / Q000150:complications; D001706:Biopsy; D003111:Colonic Polyps / Q000150:complications; D004396:Coloring Agents; D004386:Duodenum / Q000473:pathology; D016145:Endoscopy, Digestive System / Q000379:methods*; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008286:Malabsorption Syndromes / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D011237:Predictive Value of Tests; D014741:Video Recording
D004396:Coloring Agents