Elsevier

Gastrointestinal Endoscopy

Volume 70, Issue 5, November 2009, Pages 933-941
Gastrointestinal Endoscopy

Original article
Clinical endoscopy
Endocytoscopy for the detection of microstructural features in adult patients with celiac sprue: a prospective, blinded endocytoscopy-conventional histology correlation study

https://doi.org/10.1016/j.gie.2009.04.043Get rights and content

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.

Design

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.

Setting

Academic tertiary referral center.

Patients

Forty patients (mean age 51.5 years, 70% women) with established (n = 32) or suspected (n = 8) celiac disease (CD).

Interventions

A validated scoring system (Marsh classification) was used to assess disease activity. EC criteria were independently evaluated by 2 gastroenterologists and 1 pathologist.

Main Outcome Measurements

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 450× 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.

Limitations

Single-center experience. No prospective validation of the criteria in an independent patient population.

Conclusions

EC at 450× magnification accurately identifies mucosal histopathology of advanced CD, but not early morphological changes.

Section snippets

Patients

We enrolled 40 consecutive adult patients with known CD (N = 32) with either clinically well-controlled (n = 29) or refractory (n = 3) disease or clinical and/or laboratory findings suggestive of CD (n= 8) between May 2006 and April 2007. The study was approved by the Ethics Committee of Charité Medical School (EA2/179/0).

EC procedure

The endocytoscope (Olympus Europe, Hamburg, Germany) used has a 3.4-mm outer diameter and can be passed through the working channel of a therapeutic endoscope mounted with a

Results

Patient demographics and details of histological classification of biopsy sites are shown in Table 2. Thirty-two patients had established CD. In 2 of the remaining 8 patients, CD was eventually established. The other 6 patients served as controls. In individual patients, all biopsy specimens showed the same Marsh classification except for 6 (15%) with patchy distribution. Table 3 shows the image quality of the individual EC recordings with respect to general assessment and evaluation of the

Discussion

Over the past 10 years, a number of enhancements of conventional high-resolution video endoscopy, by using water immersion for magnification, true magnification, staining, water immersion, or image processing techniques, have been evaluated. Reported sensitivity and specificity varied between 58% and 100% and 88% and 100%, respectively.20, 21, 22, 23, 24, 25, 26, 27 The accuracy of these enhanced techniques seemed promising, but methodological flaws (very high pretest probability and studying

References (31)

Cited by (38)

  • The development and clinical application of microscopic endoscopy for in vivo optical biopsies: Endocytoscopy and confocal laser endomicroscopy

    2022, Photodiagnosis and Photodynamic Therapy
    Citation Excerpt :

    Additionally, good agreement between EC and histopathology was obtained in all patients with celiac disease. However, another report noted that although pECS with 450 magnification can be used to accurately identify the mucosal histopathology of advanced celiac disease, early morphological changes cannot be detected [74]. EC has also been shown to be capable of detecting some colorectal diseases.

  • Endocytoscopy for Luminal Gastrointestinal Diseases: A Systematic Review

    2021, Techniques and Innovations in Gastrointestinal Endoscopy
  • Surveillance of long-standing colitis: The role of image-enhanced endoscopy

    2015, Best Practice and Research: Clinical Gastroenterology
    Citation Excerpt :

    Endocytoscopy is a technique that provides high (up to 1400 fold) magnification in vivo, utilizing a contact light microscope [67]. After application of a topical contrast agent, the cellular structure of the superficial mucosa can be visualized and differentiated [68–70]. Although this evolving technique has not yet been studied in IBD surveillance, the obvious clinical positioning includes differentiation of lesions suspect for neoplasia.

  • Advanced endoscopic imaging techniques in Crohn's disease

    2014, Journal of Crohn's and Colitis
    Citation Excerpt :

    The technique was shown to be reliable for the examination of gastrointestinal mucosal surfaces.76–78 In addition, EC could predict neoplasia in aberrant crypt foci and could distinguish neoplastic from non-neoplasic colorectal lesions.78,79 Our group has recently assessed the value of EC to determine single inflammatory cells in patients with IBD.80

  • Enteroscopy: Advances in diagnostic imaging

    2012, Best Practice and Research: Clinical Gastroenterology
    Citation Excerpt :

    This preliminary study shows that endocytoscopy allows in vivo, real-time, noninvasive visualisation and characterisation of villous architecture and may be a promising method for in vivo evaluation of duodenal mucosa in celiac disease [15]. In another study evaluating the usefulness of endocytoscopy for the diagnosis of celaic disease Heiko Pohl et al prospectively studied 166 endocytoscopy recordings of forty patients with established (n = 32) or suspected (n = 8) celiac disease [16]. Of the 166 duodenal biopsy sites, 23% were classified as Marsh III (moderate to severe), 10% as Marsh I (mild), and 67% as Marsh 0 (normal).

View all citing articles on Scopus

DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

If you would like to chat with an author of this article, you may contact him at [email protected], www.danielbaumgart.de, or www.danielbaumgart.us.

View full text