In vivo real-time imaging of human duodenal mucosal structures in celiac disease using endocytoscopy.
OBJECTIVE
Celiac disease is a gluten-induced enteropathy whose diagnosis is based on histological evidence of villous atrophy. The diagnosis may be difficult if the orientation of histological sections is other than optimal. During upper gastrointestinal endoscopy we studied in vivo duodenal mucosa in patients with celiac disease using endocytoscopy, a novel diagnostic technique allowing in vivo real-time visualization of mucosa under x 450 magnification.


METHODS
Sixteen patients with documented celiac disease and seven controls without celiac disease were studied. Endocytoscopic images obtained from several fields were compared in a blinded fashion to standard histology.


RESULTS
Endocytoscopy showed three different patterns of in vivo histology: (1) the presence of normal-appearing, long, thin villi, lined with clearly distinguishable surface epithelial cells, considered to be normal duodenal mucosa (n = 15, all controls and eight celiac disease patients); (2) the presence of thick, shortened villi, reflecting partial villous atrophy (n = 4); and (3) the total absence of villi and the presence of enlarged crypt orifices, reflecting total villous atrophy (n = 4). Good concordance between endocytoscopy and standard histology was found in all 16 patients with celiac disease.


CONCLUSIONS
Endocytoscopy allows in vivo, real-time, noninvasive visualization and characterization of villous architecture and may be a promising method for in vivo evaluation of duodenal mucosa in celiac disease.
Matysiak-Budnik
T
T
Institut des Maladies de l'Appareil Digestif - INSERM U913, CIC 04 et Service d'Hépato-Gastroentérologie, Hôtel Dieu, CHU de Nantes, 44093 Nantes, France. tamara.matysiakbudnik@chu-nantes.fr
Coron
E
E
Mosnier
J-F
JF
Le Rhun
M
M
Inoue
H
H
Galmiche
J-P
JP
D000328:Adult; D000368:Aged; D001284:Atrophy / Q000473:pathology; D001706:Biopsy; D016022:Case-Control Studies; D002446:Celiac Disease / Q000473:pathology*; D004384:Duodenoscopy / Q000379:methods*; D004386:Duodenum / Q000473:pathology*; D019723:Endoscopes; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008875:Middle Aged