Reliability of the "immersion technique" during routine upper endoscopy for detection of abnormalities of duodenal villi in patients with dyspepsia.
BACKGROUND
Upper endoscopy is not routinely performed to directly detect abnormalities of the duodenal villi. The reliability of the immersion technique for assessment of duodenal villi was evaluated in a series of patients with dyspepsia.


METHODS
A total of 396 patients who were to undergo standard EGD for dyspeptic symptoms were enrolled. Patients with suspected malabsorption were excluded. By performing a "modified immersion technique," duodenal villi were scored as the following: definitely present, partially present, or definitely absent. Three duodenal biopsy specimens were obtained from each patient, and villi also were scored histologically as the following: normal, partial villous pattern, or total villous atrophy.


RESULTS
Sensitivity, specificity, and positive and negative predictive values of the modified immersion technique for detection of total villous atrophy were 100%, 99.7%, 85.7%, and 100%, respectively. Sensitivity, specificity, and positive and negative predictive values of modified immersion technique for detection of partial villous patterns were 75%, 99.5%, 60%, and 99.7%, respectively. Sensitivity, specificity, and positive and negative predictive values for modified immersion technique detection of any villous abnormality (partial or total villous atrophy) were 90.9%, 99.5%, 83.3%, and 99.7%, respectively.


CONCLUSIONS
During standard EGD, duodenal evaluation by modified immersion technique can reliably detect abnormalities of duodenal villi. This simple diagnostic technique may be performed routinely during endoscopic exploration of duodenum.
Department of Internal Medicine and Gastroenterology, Institute of Histopathology, Catholic University of Medicine and Surgery, Rome, Italy.
Giovanni
G
Cammarota
Giuseppe A
GA
Pirozzi
Antonio
A
Martino
Giuseppe
G
Zuccalà
Rossella
R
Cianci
Lucio
L
Cuoco
Veronica
V
Ojetti
Matteo
M
Landriscina
Massimo
M
Montalto
Fabio M
FM
Vecchio
Giovanni
G
Gasbarrini
Antonio
A
Gasbarrini
D001284:Atrophy; D002446:Celiac Disease / Q000473:pathology; D004386:Duodenum / Q000473:pathology*; D004415:Dyspepsia / Q000473:pathology*; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D006801:Humans; D007101:Immersion; D008297:Male; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity