title: Endocytoscopy for the detection of microstructural features in adult patients with celiac sprue: a prospective, blinded endocytoscopy-conventional histology correlation study.
abstract: 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.
authors: Division of Gastroenterology and Hepatology, Department of Medicine, Charité Medical Center, Virchow Hospital, Medical School of Humboldt-University of Berlin, Berlin, Germany.
authors: Heiko
authors: H
authors: Pohl
authors: Thomas
authors: T
authors: Rösch
authors: Barbara T
authors: BT
authors: Tanczos
authors: Birgit
authors: B
authors: Rudolph
authors: Karsten
authors: K
authors: Schlüns
authors: Daniel C
authors: DC
authors: Baumgart
mesh_terms: 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