Direct visualization of intestinal villi by high-resolution magnifying upper endoscopy: a validation study.
BACKGROUND
New generation videoendoscopes potentially may visualize duodenal villi. This study compared endoscopic findings with this type of instrument to the histopathologic evaluation of duodenal villi.


METHODS
A total of 191 patients underwent upper endoscopy for the purpose of obtaining duodenal biopsy specimens. The findings were assessed independently by 3 experienced observers by using a commercially available, high-resolution, high-magnifying (x2) videoendoscope. The duodenal villous profile was determined by endoscopic magnification and by endoscopic magnification after filling the duodenum with water. With both endoscopic magnification and endoscopic magnification after filling the duodenum with water, villous patterns were scored as the following: definitely present, partially present, or definitely absent. Villous patterns also were histopathologically scored as the following: normal, partial villous pattern, or total villous atrophy.


RESULTS
Interobserver variability was excellent (kappa = 0.93). The concordance between either endoscopic magnification or endoscopic magnification after filling the duodenum with water and histology was 100% for presence/absence of villi. The sensitivity, the specificity, and the positive and negative predictive values of endoscopic magnification for detection of any villous abnormality were 95%, 99%, 95%, and 99%, respectively; the respective values of endoscopic magnification after filling the duodenum with water were 95%, 98%, 92%, and 99%.


CONCLUSIONS
High-resolution magnifying upper endoscopy can reliably predict the presence or the absence of duodenal villi.
Cammarota
Giovanni
G
Department of Internal Medicine, Institute of Pathology, Catholic University of Medicine and Surgery, Rome, Italy.
Martino
Antonio
A
Pirozzi
Giuseppe A
GA
Cianci
Rossella
R
Cremonini
Filippo
F
Zuccalà
Giuseppe
G
Cuoco
Lucio
L
Ojetti
Veronica
V
Montalto
Massimo
M
Vecchio
Fabio M
FM
Gasbarrini
Antonio
A
Gasbarrini
Giovanni
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy; D002446:Celiac Disease / Q000175:diagnosis; D002908:Chronic Disease; D004382:Duodenitis / Q000175:diagnosis; D004386:Duodenum / Q000473:pathology*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005756:Gastritis / Q000175:diagnosis; D005767:Gastrointestinal Diseases / Q000175:diagnosis*; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D007421:Intestine, Small / Q000382:microbiology; D043183:Irritable Bowel Syndrome / Q000175:diagnosis; D008297:Male; D008875:Middle Aged