title: Role of the "immersion technique" in diagnosing celiac disease with villous atrophy limited to the duodenal bulb.
abstract: OBJECTIVE
  To investigate if the so-called immersion technique during upper endoscopy may be helpful to predict patterns of villous atrophy restricted to the duodenal bulb.
  
  
  BACKGROUND
  Patients with celiac disease may have a patchy distribution of duodenal villous atrophy. In some cases, mucosa of duodenal bulb may be the only intestinal area involved. The immersion technique is a novel procedure that allows visualizing duodenal villi directly during endoscopy.
  
  
  METHODS
  With this prospective study, the immersion duodenoscopy was performed in 67 celiac subjects to investigate their duodenal villous pattern. Villi were evaluated both in the first and in the second duodenal segment and judged as present or absent (flat mucosa). Results were compared with histology as reference.
  
  
  RESULTS
  Among celiac subjects, 49 were newly diagnosed and 18 previously diagnosed celiac patients. Four (8%) newly diagnosed and 7 (39%) previously diagnosed celiac subjects had an extension of the villous atrophy (flat mucosa) limited to the duodenal bulb. The sensitivity, specificity, and positive and negative predictive values of the immersion-based duodenal investigation in predicting areas of duodenal villous atrophy was always 100%.
  
  
  CONCLUSIONS
  Immersion technique may be useful for directing duodenal biopsies in celiac subjects with a patchy distribution of villous atrophy. This procedure can avoid blinded sampling of the duodenal mucosa and enhance the diagnostic yield.
authors.affiliation: Department of Internal Medicine, Catholic University of Medicine and Surgery, Rome, Italy. gcammarota@rm.unicatt.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cammarota
authors.forename: Paola
authors.initials: P
authors.lastname: Cesaro
authors.forename: Rossella
authors.initials: R
authors.lastname: La Mura
authors.forename: Antonio
authors.initials: A
authors.lastname: Martino
authors.forename: Alessia
authors.initials: A
authors.lastname: Cazzato
authors.forename: Luca
authors.initials: L
authors.lastname: Miele
authors.forename: Andrea
authors.initials: A
authors.lastname: Lupascu
authors.forename: Fabio M
authors.initials: FM
authors.lastname: Vecchio
authors.forename: Luigi M
authors.initials: LM
authors.lastname: Larocca
authors.forename: Antonio
authors.initials: A
authors.lastname: Grieco
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gasbarrini
mesh_terms: D000293:Adolescent; D000328:Adult; D001284:Atrophy; D002446:Celiac Disease / Q000175:diagnosis*; D004386:Duodenum / Q000473:pathology / Q000648:ultrastructure*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement; D007413:Intestinal Mucosa / Q000473:pathology / Q000648:ultrastructure*; D008297:Male; D008871:Microvilli / Q000473:pathology; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity