A prospective endoscopic study of scalloped folds and grooves in the mucosa of the duodenum as signs of villous atrophy.
BACKGROUND
Scalloping of the valvulae conniventes visible at endoscopy may predict the presence of villous atrophy. This prospective study was designed to discover how commonly duodenal mucosal scallops and grooves occurred and to delineate their relationship to villous atrophy.


METHODS
All patients undergoing upper gastrointestinal endoscopy by a single observer over 5 years were included. After inspection of the duodenal mucosa, biopsy samples were taken from those in whom the mucosa was abnormal (n = 26) and from those in whom it was not, but where biopsy was indicated (n = 100).


RESULTS
None of the 100 endoscopically normal controls had subtotal villous atrophy: 94 had normal histology, 2 had non-atrophic change, and 4 had partial villous atrophy; 14 of the 26 individuals (54%) with abnormal duodena had subtotal villous atrophy, 7 having both scallops and grooves. Four had scallops alone, and three had grooves only. All patients with both scallops and grooves had subtotal villous atrophy (100%), the positive predictive value of which was 36% for scallops alone and 38% for grooves alone.


CONCLUSIONS
Scallops and grooves together indicate that subtotal villous atrophy is very likely histologically, even when that diagnosis has not been suspected. A normal duodenum excludes it.
Smith
A D
AD
Department of Medicine, The Ayr Hospital, Scotland, United Kingdom.
Graham
I
I
Rose
J D
JD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy / Q000473:pathology; D001707:Biopsy, Needle; D004378:Duodenal Diseases / Q000473:pathology*; D004386:Duodenum / Q000473:pathology; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity