Role of the "immersion technique" in diagnosing celiac disease with villous atrophy limited to the duodenal bulb.
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.
Cammarota
Giovanni
G
Department of Internal Medicine, Catholic University of Medicine and Surgery, Rome, Italy. gcammarota@rm.unicatt.it
Cesaro
Paola
P
La Mura
Rossella
R
Martino
Antonio
A
Cazzato
Alessia
A
Miele
Luca
L
Lupascu
Andrea
A
Vecchio
Fabio M
FM
Larocca
Luigi M
LM
Grieco
Antonio
A
Gasbarrini
Giovanni
G
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