Water-immersion technique during standard upper endoscopy may be useful to drive the biopsy sampling of duodenal mucosa in children with celiac disease.
OBJECTIVE
To evaluate the accuracy of the water-immersion technique during upper endoscopy in recognizing the duodenal villous pattern in a series of children who were undergoing endoscopy to obtain duodenal biopsy for histological analysis.


METHODS
The water-immersion technique was performed in 19 children. Endoscopic findings were compared with histology. Results were assessed on per biopsy analysis and per patient analysis, taking into account the worst endoscopic finding in each patient and correlating it with the worst histological diagnosis.


RESULTS
Per biopsy analysis: A total of 57 biopsy specimens were obtained and assessed. The endoscopic duodenal investigation correctly identified 53 areas (93%), which corresponded to histology, giving it an accuracy rate of 93%. Per patient analysis: The worst histology of the duodenal bulb was predicted by endoscopy in 18 of the 19 enrolled patients (95%), whereas the worst histopathological lesion of the second portion of the duodenum was recognized in 100% of cases. On the whole, therefore, the endoscopist suggested a diagnosis of celiac disease in 11 patients, with both positive and negative predictive values of 100%.


CONCLUSIONS
The water-immersion technique during upper endoscopy is highly accurate in recognizing the duodenal villous pattern in subjects who need a duodenal investigation. Our findings encourage a cost-saving and patient-retaining approach to the diagnosis of celiac disease by driving biopsy and reducing the number of duodenal samplings.
Cammarota
Giovanni
G
Department of Internal Medicine, Agostino Gemelli University Hospital, Endoscopy Unit, Institute of Histopathology, Catholic University of Medicine and Surgery, Rome, Italy. gcammarota@rm.unicatt.it
Cazzato
Alessia
A
Genovese
Orazio
O
Pantanella
Adriano
A
Ianiro
Gianluca
G
Giorgio
Valentina
V
Montalto
Massimo
M
Vecchio
Fabio M
FM
Larocca
Luigi M
LM
Gasbarrini
Giovanni
G
Fundarò
Carlo
C
D000293:Adolescent; D001706:Biopsy; D002446:Celiac Disease / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D004386:Duodenum / Q000473:pathology*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D012680:Sensitivity and Specificity; D014867:Water
D014867:Water