title: High definition endoscopy with or without I-Scan increases the detection of celiac disease during routine endoscopy.
abstract: OBJECTIVE
  Celiac disease remains underdiagnosed at endoscopy. We aimed to assess the utility of I-Scan (virtual chromo-endoscopy) to improve sensitivity of endoscopy to detect markers of villous atrophy in this condition.
  
  
  METHODS
  Patients from 2 UK hospitals were studied in 3 groups. Group 1: standard high definition, white light endoscopy (WLE); Group 2: WLE plus I-Scan; Group 3: non-high definition control group. The presence of endoscopic markers was recorded. At least 4 duodenal biopsies were taken from all patients. Serology was performed concurrently and observations were compared with histology.
  
  
  RESULTS
  758 patients (62% female, mean age 52) were recruited (Group 1: 230; Group 2: 228; Group 3: 300). 135 (17.8%) new diagnoses of coeliac disease were made (21 Group 1; 24 Group 2; 89 Group 3). The sensitivity for detection of endoscopic markers of villous atrophy was significantly higher in both Group 1 (85.7%, p=0.0004) and Group 2 (75%, p=0.005) compared to non-high definition controls (41.6%). There was no significant difference between high definition only and I-Scan groups (p=0.47). In non-high definition endoscopy a missed diagnosis was associated with lesser degrees of villous atrophy (p=0.019) and low tTG titre (p=0.007).
  
  
  CONCLUSIONS
  High definition endoscopy with or without I-Scan increases the detection of celiac disease during routine endoscopy.
authors.affiliation: Royal Hallamshire Hospital, Sheffield, UK. Electronic address: h.penny@sheffield.ac.uk.
authors.forename: Hugo A
authors.initials: HA
authors.lastname: Penny
authors.affiliation: Royal Hallamshire Hospital, Sheffield, UK.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Mooney
authors.affiliation: Royal Hallamshire Hospital, Sheffield, UK.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Burden
authors.affiliation: St Mary's Hospital, London, UK.
authors.forename: Nisha
authors.initials: N
authors.lastname: Patel
authors.affiliation: Royal Hallamshire Hospital, Sheffield, UK.
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Johnston
authors.affiliation: Royal Hallamshire Hospital, Sheffield, UK.
authors.forename: Simon H
authors.initials: SH
authors.lastname: Wong
authors.affiliation: St Mary's Hospital, London, UK.
authors.forename: Julian
authors.initials: J
authors.lastname: Teare
authors.affiliation: Royal Hallamshire Hospital, Sheffield, UK.
authors.forename: David S
authors.initials: DS
authors.lastname: Sanders
mesh_terms: D002446:Celiac Disease / Q000000981:diagnostic imaging* / Q000473:pathology; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000000981:diagnostic imaging* / Q000473:pathology; D016015:Logistic Models; D008131:London; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012680:Sensitivity and Specificity
keywords: Celiac disease; High definition endoscopy; I-Scan