title: Lack of endoscopic visualization of intestinal villi with the "immersion technique" in overt atrophic celiac disease.
abstract: BACKGROUND
  The endoscopic appearance of the duodenal folds can predict the presence of celiac disease. However, endoscopic alterations can be minimal and the disease can have a "patchy" distribution histopathologically. The observation that intestinal villi can be better visualized when the duodenum is filled with water led to the development of an endoscopic "immersion technique" to assess celiac disease.
  
  
  METHODS
  Endoscopy with duodenal biopsies was performed in 20 patients with malabsorption syndrome (positive for antiendomysial antibodies) and in 30 patients with reflux-like symptoms (negative for antiendomysial antibodies). Duodenal hypotonia was induced pharmacologically, water was introduced, and the mucosa was observed for the presence of villi. Photographs were obtained for subsequent analysis. The endoscopic appearance was classified from 1 (folds certainly present) to 4 ("scalloped valvulae"); villous structures were classified from 1 (definitely present) to 3 (definitely absent).
  
  
  RESULTS
  Celiac disease was confirmed histopathologically in all patients with positive antiendomysial antibodies. The endoscopic appearance of the duodenum with air insufflation alone had a positive predictive value for the diagnosis of celiac disease of 84% and a specificity of 87%. Visualization of villi with the "immersion technique" had a higher positive predictive value (99%) and specificity (99%).
  
  
  CONCLUSIONS
  A lack of visualization of intestinal villi in the descending duodenum with the "immersion technique" may increase the diagnostic accuracy of endoscopy for celiac disease. This technique could also be useful for targeting duodenal biopsies.
authors.affiliation: Internal Medicine and Gastroenterology, Gemelli Teaching Hospital, Catholic University of Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Gasbarrini
authors.forename: Veronica
authors.initials: V
authors.lastname: Ojetti
authors.forename: Lucio
authors.initials: L
authors.lastname: Cuoco
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cammarota
authors.forename: Alessio
authors.initials: A
authors.lastname: Migneco
authors.forename: Alessandro
authors.initials: A
authors.lastname: Armuzzi
authors.forename: Paolo
authors.initials: P
authors.lastname: Pola
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gasbarrini
mesh_terms: D000328:Adult; D001323:Autoantibodies / Q000032:analysis; D002446:Celiac Disease / Q000175:diagnosis*; D004386:Duodenum / Q000473:pathology*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D007327:Insufflation; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014867:Water
chemical_list: D001323:Autoantibodies; D014867:Water