TY - JOUR
T1 - Classification of villous atrophy with enhanced magnification endoscopy in patients with celiac disease and tropical sprue
AU - Lo, Amy
AU - Guelrud, Moises
AU - Essenfeld, Harold
AU - Bonis, Peter
PY - 2007/8
Y1 - 2007/8
N2 - Background: Intestinal lesions in celiac disease (CD) and tropical sprue (TS) can be patchy. Improved endoscopic identification of affected areas may increase the diagnostic yield of biopsy specimens. Enhanced magnification endoscopy [EME] combines magnification endoscopy with 3% acetic acid instillation. Objective: This study describes endoscopic findings associated with villous atrophy during EME. Design: Patients underwent EME with a magnifying endoscope with acetic-acid application. Surface mucosal patterns were characterized before and after acetic-acid spraying. Observed surface patterns were compared with histologic results obtained from a single targeted biopsy specimen. Setting: Policlinica Metropolitana in Caracas, Venezuela. Patients: Patients with diagnosed but untreated CD or TS. Results: Fifty-two biopsy specimens were obtained from 27 patients (17 men, 10 women; mean age 50.5 years; range, 24-76 years; 12 with CD and 15 with TS). EME of the duodenum revealed 4 different mucosal patterns: I, normal; II, stubbed; III, ridged; and IV, foveolar. Three of the 4 patterns were strongly associated with the presence of villous atrophy (pattern I, 1/18 [5.5%]; II, 16/17 [94%]; III, 12/12 [100%]; and IV, 5/5 [100%]). EME was more sensitive than standard endoscopy for detecting villous atrophy, 100% versus 58% in CD and 93% versus 20% in TS. Furthermore, EME identified patchy areas of partial villous atrophy in 16 patients (5 CD and 11 TS) in whom standard endoscopy was normal. Conclusions: EME identifies 3 characteristic endoscopic patterns that correlate with the presence of villous atrophy. EME could help identify patchy areas of partial mucosal atrophy, potentially reducing the need for blind biopsies.
AB - Background: Intestinal lesions in celiac disease (CD) and tropical sprue (TS) can be patchy. Improved endoscopic identification of affected areas may increase the diagnostic yield of biopsy specimens. Enhanced magnification endoscopy [EME] combines magnification endoscopy with 3% acetic acid instillation. Objective: This study describes endoscopic findings associated with villous atrophy during EME. Design: Patients underwent EME with a magnifying endoscope with acetic-acid application. Surface mucosal patterns were characterized before and after acetic-acid spraying. Observed surface patterns were compared with histologic results obtained from a single targeted biopsy specimen. Setting: Policlinica Metropolitana in Caracas, Venezuela. Patients: Patients with diagnosed but untreated CD or TS. Results: Fifty-two biopsy specimens were obtained from 27 patients (17 men, 10 women; mean age 50.5 years; range, 24-76 years; 12 with CD and 15 with TS). EME of the duodenum revealed 4 different mucosal patterns: I, normal; II, stubbed; III, ridged; and IV, foveolar. Three of the 4 patterns were strongly associated with the presence of villous atrophy (pattern I, 1/18 [5.5%]; II, 16/17 [94%]; III, 12/12 [100%]; and IV, 5/5 [100%]). EME was more sensitive than standard endoscopy for detecting villous atrophy, 100% versus 58% in CD and 93% versus 20% in TS. Furthermore, EME identified patchy areas of partial villous atrophy in 16 patients (5 CD and 11 TS) in whom standard endoscopy was normal. Conclusions: EME identifies 3 characteristic endoscopic patterns that correlate with the presence of villous atrophy. EME could help identify patchy areas of partial mucosal atrophy, potentially reducing the need for blind biopsies.
UR - http://www.scopus.com/inward/record.url?scp=34447539926&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=34447539926&partnerID=8YFLogxK
U2 - 10.1016/j.gie.2007.02.041
DO - 10.1016/j.gie.2007.02.041
M3 - Article
C2 - 17643717
AN - SCOPUS:34447539926
SN - 0016-5107
VL - 66
SP - 377
EP - 382
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 2
ER -