Celiac.com 02/24/2010 - Proper clinical diagnosis of celiac disease still relies on confirmation of histological evidence of villous atrophy via biopsy. Getting a good sample can sometimes be tricky. If histological sections are not optimally oriented, then diagnosis may be more difficult. As a result, doctors can sometimes fail to confirm the proper diagnosis.

A team of researchers recently set out to study the viability of confirming histological evidence of villous atrophy in real time, during upper gastrointestinal endoscopy, in live duodenal mucosa of patients with celiac disease, using endocytoscopy, a novel diagnostic technique allowing in vivo real-time visualization of mucosa under 450x magnification.

The research team included T.  Matysiak-Budnik, E.  Coron1, J.-F.  Mosnier, M.  Le Rhun1, H.  Inoue, and J.-P.  Galmiche. They are associated variously with the Institut des Maladies de l'Appareil Digestif - INSERM U913, CIC 04 et Service d'Hépato-Gastroentérologie, Hôtel Dieu, CHU de Nantes, France, the Service d'Anatomie Pathologique, E.A. Biometadys, CHU de Nantes, France, and the Digestive Disease Center, Showa University Northern Yokohama Hospital, Japan

The team studied sixteen subjects with clinically proven celiac disease, together with seven controls subjects with no celiac disease. They took endocytoscopic images from multiple areas and then made a blind comparison against standard histology.

Endocytoscopy revealed three distinct patterns of in vivo histology.

First, in all controls and eight celiac disease patients (n = 15), endocytoscopy revealed the presence of normal-appearing, long, thin villi, lined with clearly distinguishable surface epithelial cells, considered to be normal duodenal mucosa.

Second, in four celiac disease patients, endocytoscopy revealed the presence of thick, shortened villi, reflecting partial villous atrophy.

Finally, in four celiac disease patients, endocytoscopy revealed the total absence of villi, along with the presence of enlarged crypt orifices, reflecting total villous atrophy.

The team found solid agreement between endocytoscopy and standard histology in all 16 patients with celiac disease.

From their results, they conclude that endocytoscopy permits live, real-time, noninvasive imaging and assessment of villous architecture, and looks to be a promising method for in vivo evaluation of duodenal mucosa in celiac disease.

Source:
Endoscopy: DOI: 10.1055/s-0029-12438

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