Narrow band imaging combined with water immersion technique in the diagnosis of celiac disease

作者：Valitutti Francesco; Oliva Salvatore; Iorfida Donatella; Aloi Marina; Gatti Silvia; Trovato Chiara Maria; Montuori Monica; Tiberti Antonio; Cucchiara Salvatore; Di Nardo Giovanni^*

来源：Digestive and Liver Disease, 2014, 46(12): 1099-1102.

DOI：10.1016/j.dld.2014.08.039

• Celiac disease
• Narrow band imaging
• Small bowel biopsy
• Water immersion technique

Background: The "multiple-biopsy" approach both in duodenum and bulb is the best strategy to confirm the diagnosis of celiac disease; however, this increases the invasiveness of the procedure itself and is time-consuming.
Aim: To evaluate the diagnostic yield of a single biopsy guided by narrow-band imaging combined with water immersion technique in paediatric patients.
Methods: Prospective assessment of the diagnostic accuracy of narrow-band imaging/water immersion technique-driven biopsy approach versus standard protocol in suspected celiac disease.
Results: The experimental approach correctly diagnosed 35/40 children with celiac disease, with an overall diagnostic sensitivity of 87.5% (95% CI: 77.3-97.7). An altered pattern of narrow-band imaging/water immersion technique endoscopic visualization was significantly associated with villous atrophy at guided biopsy (Spearman Rho 0.637, p < 0.001). Concordance of narrow-band imaging/water immersion technique endoscopic assessments was high between two operators (K: 0.884). The experimental protocol was highly timesaving compared to the standard protocol.
Conclusions: An altered narrow-band imaging/water immersion technique pattern coupled with high anti-transglutaminase antibodies could allow a single guided biopsy to diagnose celiac disease. When no altered mucosal pattern is visible even by narrow-band imaging/water immersion technique, multiple bulbar and duodenal biopsies should be obtained.

• 出版日期2014-12