title: Narrow band imaging combined with water immersion technique in the diagnosis of celiac disease.
abstract: BACKGROUND
  The "multiple-biopsy" approach both in duodenum and bulb is the best strategy to confirm the diagnosis of celiac disease; however, this increases the invasiveness of the procedure itself and is time-consuming.
  
  
  OBJECTIVE
  To evaluate the diagnostic yield of a single biopsy guided by narrow-band imaging combined with water immersion technique in paediatric patients.
  
  
  METHODS
  Prospective assessment of the diagnostic accuracy of narrow-band imaging/water immersion technique-driven biopsy approach versus standard protocol in suspected celiac disease.
  
  
  RESULTS
  The experimental approach correctly diagnosed 35/40 children with celiac disease, with an overall diagnostic sensitivity of 87.5% (95% CI: 77.3-97.7). An altered pattern of narrow-band imaging/water immersion technique endoscopic visualization was significantly associated with villous atrophy at guided biopsy (Spearman Rho 0.637, p<0.001). Concordance of narrow-band imaging/water immersion technique endoscopic assessments was high between two operators (K: 0.884). The experimental protocol was highly timesaving compared to the standard protocol.
  
  
  CONCLUSIONS
  An altered narrow-band imaging/water immersion technique pattern coupled with high anti-transglutaminase antibodies could allow a single guided biopsy to diagnose celiac disease. When no altered mucosal pattern is visible even by narrow-band imaging/water immersion technique, multiple bulbar and duodenal biopsies should be obtained.
authors.affiliation: Pediatric Gastroenterology and Liver Unit, Department of Pediatrics, Sapienza University of Rome, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Valitutti
authors.affiliation: Pediatric Gastroenterology and Liver Unit, Department of Pediatrics, Sapienza University of Rome, Rome, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Oliva
authors.affiliation: Pediatric Gastroenterology and Liver Unit, Department of Pediatrics, Sapienza University of Rome, Rome, Italy.
authors.forename: Donatella
authors.initials: D
authors.lastname: Iorfida
authors.affiliation: Pediatric Gastroenterology and Liver Unit, Department of Pediatrics, Sapienza University of Rome, Rome, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Aloi
authors.affiliation: Pediatric Gastroenterology and Liver Unit, Department of Pediatrics, Sapienza University of Rome, Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Gatti
authors.affiliation: Pediatric Gastroenterology and Liver Unit, Department of Pediatrics, Sapienza University of Rome, Rome, Italy.
authors.forename: Chiara Maria
authors.initials: CM
authors.lastname: Trovato
authors.affiliation: Pediatric Gastroenterology and Liver Unit, Department of Pediatrics, Sapienza University of Rome, Rome, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Montuori
authors.affiliation: Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Tiberti
authors.affiliation: Pediatric Gastroenterology and Liver Unit, Department of Pediatrics, Sapienza University of Rome, Rome, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Cucchiara
authors.affiliation: Pediatric Gastroenterology and Liver Unit, Department of Pediatrics, Sapienza University of Rome, Rome, Italy. Electronic address: giovanni.dinardo@uniroma1.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Nardo
mesh_terms: D000293:Adolescent; D001706:Biopsy / Q000379:methods; D002446:Celiac Disease / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D004384:Duodenoscopy / Q000379:methods*; D004386:Duodenum / Q000473:pathology*; D005260:Female; D006801:Humans; D007101:Immersion; D007223:Infant; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D062048:Narrow Band Imaging; D011446:Prospective Studies; D016037:Single-Blind Method
keywords: Celiac disease; Narrow band imaging; Small bowel biopsy; Water immersion technique