Endocytoscopy for the detection of microstructural features in adult patients with celiac sprue: a prospective, blinded endocytoscopy-conventional histology correlation study.
BACKGROUND
Endocytoscopy (EC) is a novel technique that allows magnified live inspection of the intestinal mucosa.


OBJECTIVE
To evaluate EC for the detection of key pathological findings in patients with celiac sprue.


METHODS
A total of 166 EC recordings were prospectively acquired. Matched videos, images, and biopsy specimens were obtained by duodenal argon beamer labeling of the respective sites.


METHODS
Academic tertiary referral center.


METHODS
Forty patients (mean age 51.5 years, 70% women) with established (n = 32) or suspected (n = 8) celiac disease (CD).


METHODS
A validated scoring system (Marsh classification) was used to assess disease activity. EC criteria were independently evaluated by 2 gastroenterologists and 1 pathologist.


METHODS
The primary endpoint was to examine EC correlation with conventional CD histology.


RESULTS
Of 166 duodenal biopsy sites, 23% were classified as Marsh III (moderate to severe), 10% as Marsh I (mild), and 67% as Marsh 0 (normal). Using the 450x magnification, we found that identification of crypts was diagnostic for celiac pathology. Four criteria were significant predictors of Marsh III pathology when adjusted by multivariate analysis: low number of villi per visual field (<3; odds ratio [OR] 9.1; 95% CI, 1.3-62.0), confluence of villi (OR 37.1; 95% CI, 1.3-1021.2), irregular epithelial lining (OR 10.9; 95% CI, 2.5-46.7), and inability to delineate loop capillaries (OR 14.9; 95% CI, 3.3-67.0). None was a good predictor of Marsh I pathology.


CONCLUSIONS
Single-center experience. No prospective validation of the criteria in an independent patient population.


CONCLUSIONS
EC at 450x magnification accurately identifies mucosal histopathology of advanced CD, but not early morphological changes.
Pohl
Heiko
H
Division of Gastroenterology and Hepatology, Department of Medicine, Charité Medical Center, Virchow Hospital, Medical School of Humboldt-University of Berlin, Berlin, Germany.
Rösch
Thomas
T
Tanczos
Barbara T
BT
Rudolph
Birgit
B
Schlüns
Karsten
K
Baumgart
Daniel C
DC
D001706:Biopsy; D002446:Celiac Disease / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004386:Duodenum / Q000473:pathology*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results