title: The water immersion technique is easy to learn for routine use during EGD for duodenal villous evaluation: a single-center 2-year experience.
abstract: OBJECTIVE
  We investigated the learning parameters of the immersion technique for the assessment of marked villous atrophy (MVA), during routine esophagogastroduodenoscopy (EGD).
  
  
  BACKGROUND
  The immersion technique offers a proven possibility of enhancing the sensitivity of endoscopy in detecting duodenal villous atrophy patterns.
  
  
  METHODS
  Nine endoscopists with at least 2 years of experience, who had previously been trained to perform the immersion technique, searched for duodenal villi during routine EGD. In a 2-year study, duodenal villi were evaluated underwater duodenoscopy in 432 patients from whom duodenal biopsies had been, for various reasons, obtained. The endoscopic findings were compared with the histology. The learning parameters of the water immersion technique and the accuracy in detecting subjects with MVA were observed.
  
  
  RESULTS
  A total of 28 (6.5%) patients with MVA were identified during endoscopy by the trained endoscopists. All these patients were diagnosed as being celiac patients. The sensitivity, specificity, and accuracy (positive and negative predictive values) of the immersion technique in detecting MVA patterns, irrespective of the endoscopist who performed the examination, were always 100%.
  
  
  CONCLUSIONS
  The underwater evaluation of the duodenum can be efficiently and regularly performed during routine EGD by endoscopists with 2 years of experience, after a specific, brief training period. This procedure is simple, feasible, and can accurately detect MVA patterns.
authors.affiliation: Department of Internal Medicine, Endoscopy Unit, A. Gemelli University Hospital, 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: Alessia
authors.initials: A
authors.lastname: Cazzato
authors.forename: Rossella
authors.initials: R
authors.lastname: Cianci
authors.forename: Paolo
authors.initials: P
authors.lastname: Fedeli
authors.forename: Veronica
authors.initials: V
authors.lastname: Ojetti
authors.forename: Maria
authors.initials: M
authors.lastname: Certo
authors.forename: Lucia
authors.initials: L
authors.lastname: Sparano
authors.forename: Silvia
authors.initials: S
authors.lastname: Giovannini
authors.forename: Luigi M
authors.initials: LM
authors.lastname: Larocca
authors.forename: Fabio M
authors.initials: FM
authors.lastname: Vecchio
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gasbarrini
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001284:Atrophy / Q000175:diagnosis / Q000473:pathology; D002446:Celiac Disease / Q000175:diagnosis* / Q000473:pathology; D002983:Clinical Competence; D004384:Duodenoscopy / Q000379:methods* / Q000592:standards; D004386:Duodenum / Q000473:pathology* / Q000648:ultrastructure; D005260:Female; D005762:Gastroenterology / Q000193:education; D006801:Humans; D007101:Immersion; D008297:Male; D008871:Microvilli / Q000473:pathology; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014867:Water; D055815:Young Adult
chemical_list: D014867:Water