Editorial
Novel endoscopic methods for the evaluation of the small-bowel mucosa

https://doi.org/10.1016/j.gie.2007.03.1056Get rights and content

Section snippets

Intestinal mucosal disorders associated with villous atrophy

There are many mucosal disorders associated with villous atrophy (Table 1). The 2 most common diseases that cause intestinal villous atrophy in developed and developing areas are celiac disease (CD) and tropical sprue (TS), respectively. CD, also known as gluten-sensitive enteropathy, is a permanent intolerance to gluten in susceptible individuals that predominantly affects the proximal small intestine, inducing crypt hyperplasia and villous atrophy. The symptoms and histologic alterations

Endoscopic findings suggestive of villous atrophy

Characteristic endoscopic findings have been well described in CD and to a lesser extent in TS (only 15% of the patients with TS exhibit the classical endoscopic features of atrophy vs 75% of the patients with CD).8 These changes include reduced Kerckring's folds, scalloping of the mucosa on circular folds, mucosal fissures, and mosaic pattern.9, 10, 11, 12 The sensitivity of the standard endoscopy to detect macroscopic features consistent with villous atrophy varies substantially (50%-94%), in

Other endoscopic technologies and techniques used to improve the visualization of the intestinal mucosa

The modified “immersion technique” is a simple, quick, and safe method. This consists in the visualization of the villi after the rapid introduction of water (usually 100-200 mL) into the lumen of the duodenum after removal of air by suction. This technique improves the rate of detection of total (sensitivity, 100%; specificity, 99.7%) and partial villous atrophy (sensitivity, 75%; specificity, 99.5%), and can be used routinely during upper endoscopy.19 Recently, this technique very accurately

References (34)

  • F. Gong et al.

    Wireless endoscopy

    Gastrointest Endosc

    (2000)
  • A. Culliford et al.

    The value of wireless capsule endoscopy in patients with complicated celiac disease

    Gastrointest Endosc

    (2005)
  • A.D. Hopper et al.

    Capsule endoscopy: an alternative to duodenal biopsy for the recognition of villous atrophy in celiac disease?

    Dig Liver Dis

    (2007)
  • H. Yamamoto et al.

    Clinical outcomes of double-balloon endoscopy for the diagnosis and treatment of small-intestinal diseases

    Clin Gastroenterol Hepatol

    (2004)
  • W. Brugge et al.

    Medical progress: endoscopy of the upper gastrointestinal tract

    N Engl J Med

    (1999)
  • G. Oberhuber et al.

    The histopathology of celiac disease: time for a standardized report scheme for pathologists

    Eur J Gastroenterol Hepatol

    (1999)
  • B.S. Ramakrishna et al.

    Tropical malabsorption

    Postgrad Med J

    (2006)
  • Cited by (12)

    • Current technologies for the endoscopic assessment of duodenal villous pattern in celiac disease

      2015, Computers in Biology and Medicine
      Citation Excerpt :

      Recently, a new generation of endoscopic tools provided of digital magnification or zoom have been proposed on the medical scenario. They provide high resolution images (up to 100–135×) and magnified images, with the availability of more enhanced details than conventional endoscopy [30,45]. Major differences within modern and conventional instrument consist in charged computed device chips.

    • Capsule endoscopy in nonresponsive celiac disease

      2011, Gastrointestinal Endoscopy
      Citation Excerpt :

      The principal reason that may explain this discrepancy is that the majority of patients with both nonresponsive CD and biopsy-proven villous atrophy had partial villous atrophy likely reflecting partially treated CD.38 CE may have a lower accuracy to detect partial villous atrophy.14,41 Villous atrophy was accurately detected by CE in the 3 patients with total villous atrophy.

    • Optimal band imaging system: a new tool for enhancing the duodenal villous pattern in celiac disease

      2008, Gastrointestinal Endoscopy
      Citation Excerpt :

      Larger-scale studies are still needed to confirm the results of our study and to determine the cost-effectiveness of the OBI-based endoscopy system and its role compared with the currently available techniques.11-15,18,19

    • Celiac disease: Diagnosis, screening, and prognosis

      2019, Evidence-based Gastroenterology and Hepatology
    • Capsule endoscopy for patients with coeliac disease

      2018, Expert Review of Gastroenterology and Hepatology
    View all citing articles on Scopus
    View full text