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Ozaka S, Takahashi H, Hamano T, Fukuda M, Mizukami K. Monomorphic Epitheliotropic Intestinal T-cell Lymphoma Presenting With Significant Villous Atrophy in the Small Intestine. Cureus 2025; 17:e79496. [PMID: 40134998 PMCID: PMC11936312 DOI: 10.7759/cureus.79496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2025] [Indexed: 03/27/2025] Open
Abstract
Monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) is a rare and aggressive primary intestinal T-cell lymphoma with a high mortality rate and poor prognosis. Although endoscopy plays a key role in early diagnosis, reports on detailed endoscopic findings are limited. Here, we present a case of MEITL with refractory diarrhea and significant villous atrophy, as observed on endoscopy. A 67-year-old woman was admitted to our hospital with refractory diarrhea and weight loss. Esophagogastroduodenoscopy revealed microgranular mucosa with significant villous atrophy in the duodenum. Enhanced magnifying endoscopy with narrow band imaging showed flattening and loss pattern of the villi in the transverse part of the duodenum. Colonoscopy also showed significant villous atrophy in the ileum. Biopsy specimens from the duodenum and ileum showed diffuse proliferation of small- to medium-sized atypical lymphoid cells in the lamina propria and intraepithelial lymphocytes. Immunohistochemistry revealed that the cells were positive for CD3, CD8, CD56, and Granzyme B. Diagnosing MEITL, PVPP (sobuzoxane, etoposide, and prednisone) chemotherapy was administered. However, since the patient developed intestinal obstruction after two courses of chemotherapy, it was discontinued. The patient died of intestinal perforation 82 days after diagnosis. MEITL can cause villous atrophy in the small intestine. Hence, magnifying endoscopy and follow-up histological examination are essential when villous atrophy is observed in patients with refractory diarrhea.
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Affiliation(s)
- Sotaro Ozaka
- Department of Gastroenterology, Faculty of Medicine, Oita University, Yufu, JPN
| | - Haruhiko Takahashi
- Department of Gastroenterology, Faculty of Medicine, Oita University, Yufu, JPN
| | - Tomoe Hamano
- Department of Gastroenterology, Faculty of Medicine, Oita University, Yufu, JPN
| | - Masahide Fukuda
- Department of Gastroenterology, Faculty of Medicine, Oita University, Yufu, JPN
| | - Kazuhiro Mizukami
- Department of Gastroenterology, Faculty of Medicine, Oita University, Yufu, JPN
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Shiha MG, Yusuf A, Sanders DS. Role of endoscopy in the diagnosis of coeliac disease: a narrative review. Transl Gastroenterol Hepatol 2024; 9:51. [PMID: 39091660 PMCID: PMC11292106 DOI: 10.21037/tgh-23-122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/01/2024] [Indexed: 08/04/2024] Open
Abstract
Background and Objective Coeliac disease (CD) is a common autoimmune disorder triggered by gluten consumption in genetically predisposed individuals. CD is characterised by chronic inflammation in the small bowel mucosa with an influx of lymphocytes, followed by crypt hyperplasia and villous atrophy. The gold standard test to diagnose CD is endoscopy with duodenal biopsies. However, variations in practice between endoscopists can lead to missed diagnoses. This review aims to discuss the role of endoscopy in the diagnosis of CD, highlighting the performance measures of endoscopy in CD and the advancement in endoscopic techniques for the optical diagnosis of villous atrophy. Methods We searched PubMed and Google Scholar from their inception to December 2023 for relevant articles on the role of endoscopy in CD. Two authors reviewed these references, and relevant studies were included in the discussion section of this review. Key Content and Findings We provide an up-to-date assessment of the diagnostic accuracy of endoscopic markers of CD and the performance of enhanced endoscopic imaging to identify villous atrophy during endoscopy. We propose a set of benchmarks for endoscopy in CD and discuss the potential role of artificial intelligence (AI) in the endoscopic diagnosis of CD. Conclusions Performing high-quality endoscopy and identifying strategies to reduce inter-endoscopist variations may reduce missed diagnoses. Adopting advanced endoscopic techniques and embracing new technologies such as AI could enhance diagnostic accuracy and improve patient care.
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Affiliation(s)
- Mohamed G. Shiha
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Abdiazizi Yusuf
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
| | - David S. Sanders
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
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Teramoto A, Hamada S, Ogino B, Yasuda I, Sano Y. Updates in narrow-band imaging for colorectal polyps: Narrow-band imaging generations, detection, diagnosis, and artificial intelligence. Dig Endosc 2022; 35:453-470. [PMID: 36480465 DOI: 10.1111/den.14489] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 12/01/2022] [Indexed: 01/20/2023]
Abstract
Narrow-band imaging (NBI) is an optical digital enhancement method that allows the observation of vascular and surface structures of colorectal lesions. Its usefulness in the detection and diagnosis of colorectal polyps has been demonstrated in several clinical trials and the diagnostic algorithms have been simplified after the establishment of endoscopic classifications such as the Japan NBI Expert Team classification. However, there were issues including lack of brightness in the earlier models, poor visibility under insufficient bowel preparation, and the incompatibility of magnifying endoscopes in certain endoscopic platforms, which had impeded NBI from becoming standardized globally. Nonetheless, NBI continued its evolution and the newest endoscopic platform launched in 2020 offers significantly brighter and detailed images. Enhanced visualization is expected to improve the detection of polyps while universal compatibility across all scopes including magnifying endoscopy will promote the global standardization of magnifying diagnosis. Therefore, knowledge related to magnifying colonoscopy will become essential as magnification becomes standardly equipped in future models, although the advent of computer-aided diagnosis and detection may greatly assist endoscopists to ensure quality of practice. Given that most endoscopic departments will be using both old and new models, it is important to understand how each generation of endoscopic platforms differ from each other. We reviewed the advances in the endoscopic platforms, artificial intelligence, and evidence related to NBI essential for the next generation of endoscopic practice.
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Affiliation(s)
- Akira Teramoto
- Third Department of Internal Medicine, Toyama University Hospital, Toyama, Japan
| | - Seiji Hamada
- Gastrointestinal Center, Urasoe General Hospital, Okinawa, Japan
| | - Banri Ogino
- Third Department of Internal Medicine, Toyama University Hospital, Toyama, Japan
| | - Ichiro Yasuda
- Third Department of Internal Medicine, Toyama University Hospital, Toyama, Japan
| | - Yasushi Sano
- Gastrointestinal Center, Sano Hospital, Hyogo, Japan
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Felber J, Bläker H, Fischbach W, Koletzko S, Laaß M, Lachmann N, Lorenz P, Lynen P, Reese I, Scherf K, Schuppan D, Schumann M, Aust D, Baas S, Beisel S, de Laffolie J, Duba E, Holtmeier W, Lange L, Loddenkemper C, Moog G, Rath T, Roeb E, Rubin D, Stein J, Török H, Zopf Y. [Not Available]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2022; 60:790-856. [PMID: 35545109 DOI: 10.1055/a-1741-5946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jörg Felber
- Medizinische Klinik II - Gastroenterologie, Hepatologie, Endokrinologie, Hämatologie und Onkologie, RoMed Klinikum Rosenheim, Rosenheim, Deutschland
| | - Hendrik Bläker
- Institut für Pathologie, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland
| | | | - Sibylle Koletzko
- Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, LMU-Klinikum München, München, Deutschland
- Department of Pediatrics, Gastroenterology and Nutrition, School of Medicine Collegium Medicum University of Warmia and Mazury, 10-719 Olsztyn, Polen
| | - Martin Laaß
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
| | - Nils Lachmann
- Institut für Transfusionsmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Pia Lorenz
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS), Berlin, Deutschland
| | - Petra Lynen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS), Berlin, Deutschland
| | - Imke Reese
- Ernährungsberatung und -therapie Allergologie, München, Deutschland
| | - Katharina Scherf
- Institute of Applied Biosciences Department of Bioactive and Functional Food Chemistry, Karlsruhe Institute of Technology (KIT), Karlsruhe, Deutschland
| | - Detlef Schuppan
- Institut für Translationale Immunologie, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Michael Schumann
- Medizinische Klinik I für Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Deutschland
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Tabibian JH, Murray JA. Near-focus narrow-band imaging for endoscopic assessment of duodenal villi: Making the case more than ever? Gastrointest Endosc 2021; 94:1082-1084. [PMID: 34686366 DOI: 10.1016/j.gie.2021.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/04/2021] [Indexed: 12/11/2022]
Affiliation(s)
- James H Tabibian
- Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, California; Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Joseph A Murray
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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Gulati S, Emmanuel A, Ong M, Pavlidis P, Patel M, El-Menabawey T, Vackova Z, Dubois P, Murino A, Martinek J, Sethi A, Neumann H, Haji A, Hayee B. Near-focus narrow-band imaging classification of villous atrophy in suspected celiac disease: development and international validation. Gastrointest Endosc 2021; 94:1071-1081. [PMID: 34228981 DOI: 10.1016/j.gie.2021.06.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 06/25/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS There are no agreed-on endoscopic signs for the diagnosis of villous atrophy (VA) in celiac disease (CD), necessitating biopsy sampling for diagnosis. Here we evaluated the role of near-focus narrow-band imaging (NF-NBI) for the assessment of villous architecture in suspected CD with the development and further validation of a novel NF-NBI classification. METHODS Patients with a clinical indication for duodenal biopsy sampling were prospectively recruited. Six paired NF white-light endoscopy (NF-WLE) and NF-NBI images with matched duodenal biopsy sampling including the bulb were obtained from each patient. Histopathology grading used the Marsh-Oberhuber classification. A modified Delphi process was performed on 498 images and video recordings by 3 endoscopists to define NF-NBI classifiers, resulting in a 3-descriptor classification: villous shape, vascularity, and crypt phenotype. Thirteen blinded endoscopists (5 expert, 8 nonexpert) then undertook a short training module on the proposed classification and evaluated paired NF-WLE-NF-NBI images. RESULTS One hundred consecutive patients were enrolled (97 completed the study; 66 women; mean age, 51.2 ± 17.3 years). Thirteen endoscopists evaluated 50 paired NF-WLE and NF-NBI images each (24 biopsy-proven VAs). Interobserver agreement among all validators for the diagnosis of villous morphology using the NF-NBI classification was substantial (κ = .71) and moderate (κ = .46) with NF-WLE. Substantial agreement was observed between all 3 NF-NBI classification descriptors and histology (weighted κ = 0.72-.75) compared with NF-WLE to histology (κ = .34). A higher degree of confidence using NF-NBI was observed when assessing the duodenal bulb. CONCLUSIONS We developed and validated a novel NF-NBI classification to reliably diagnose VA in suspected CD. There was utility for expert and nonexpert endoscopists alike, using readily available equipment and requiring minimal training. (Clinical trial registration number: NCT04349904.).
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Affiliation(s)
- Shraddha Gulati
- King's Institute of Therapeutic Endoscopy, King's College Hospital, London, UK
| | - Andrew Emmanuel
- King's Institute of Therapeutic Endoscopy, King's College Hospital, London, UK
| | - Mark Ong
- Department of Histopathology, King's College Hospital, London, UK
| | | | - Mehul Patel
- King's Institute of Therapeutic Endoscopy, King's College Hospital, London, UK
| | | | - Zuzana Vackova
- Department of Endoscopy, Institution of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Patrick Dubois
- King's Institute of Therapeutic Endoscopy, King's College Hospital, London, UK
| | - Alberto Murino
- Department of Gastroenterology, Royal Free Hospital, London, UK
| | - Jan Martinek
- Department of Endoscopy, Institution of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Amrita Sethi
- Department of Endoscopy, Columbia University Medical Center-NYPH, New York, New York, USA
| | - Helmut Neumann
- Department of Endoscopy, University Medical Center, Mainz, Germany
| | - Amyn Haji
- King's Institute of Therapeutic Endoscopy, King's College Hospital, London, UK
| | - Bu'Hussain Hayee
- King's Institute of Therapeutic Endoscopy, King's College Hospital, London, UK
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Sinha SK, Berry N, Muktesh G, Siddappa P, Basha J, Prasad K, Appasani S, Ashat M, Vaiphei K, Singh K, Kochhar R. Utility of narrow band imaging in predicting histology in celiac disease. Indian J Gastroenterol 2020; 39:370-376. [PMID: 32705418 DOI: 10.1007/s12664-020-01030-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 03/24/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Narrow band imaging (NBI) with magnification better visualizes the duodenal microsurface and mucosal vascularity. NBI delineates villous atrophy better than conventional white light endoscopy. AIMS This study was conducted to evaluate the diagnostic accuracy of narrow band imaging with magnification (NBI-ME) in celiac disease (CD). METHODS In this prospective study, consecutive patients of suspected CD and controls were subjected to tissue transglutaminase antibody test and endoscopic evaluation initially with white light followed by NBI-ME, and biopsies were taken from duodenum. Duodenal villous patterns on NBI were interpreted as normal, blunted distorted, and absent. Severity of villous atrophy was reported according to the modified Marsh criteria. RESULTS One hundred and twenty-two patients (mean age of 27.53 ± 13.37 years and a male to female ratio of 1:1.26) and 40 controls were studied. The sensitivity and specificity of NBI-ME in predicting villous atrophy were found to be 95.54% and 90%, respectively. The specificity and negative predictive value of NBI-ME in predicting villous atrophy amongst controls was 100% and 97.5%, respectively. Abnormal findings (blunted and absent villous patterns) combined with elevated transglutaminase antibody (> 5-fold) were found to have high accuracy in predicting villous atrophy. CONCLUSION NBI with magnification has high sensitivity and specificity in predicting villous atrophy in patients with celiac disease.
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Affiliation(s)
- Saroj Kant Sinha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India
| | - Neha Berry
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India
| | - Gaurav Muktesh
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India
| | - Pradeep Siddappa
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India
| | - Jahangeer Basha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India
| | - Kaushal Prasad
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India
| | - Sreekanth Appasani
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India
| | - Munish Ashat
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India
| | - Kim Vaiphei
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India
| | - Kartar Singh
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India.
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Hiraga H, Sakuraba H, Tanaka N, Watanabe R, Akemoto Y, Ota S, Kikuchi H, Sawaya M, Hiraga N, Chinda D, Hanabata N, Mikami T, Shimoyama T, Takahata T, Tanaka M, Fukuda S. A case of celiac disease with type I enteropathy-associated T-cell lymphoma in a Japanese male patient. Immunol Med 2019; 42:142-147. [PMID: 31603739 DOI: 10.1080/25785826.2019.1673031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
A 45-year-old Japanese male patient who was diagnosed with celiac disease (CeD) developed type I enteropathy-associated T-cell lymphoma (EATL). In 2013, the patient was admitted to our hospital with worsening of diarrhea and weight loss. Pathological examination of biopsy specimens from the duodenum and ileum led to a diagnosis of suspected EATL. A previous total colonoscopy (TCS) indicated villous atrophy in the terminal ileum. The patient was changed to a gluten-free diet, and the nutritional status gradually improved. In September 2014, he experienced acute right lower abdominal pain. He underwent urgent surgery, and a perforation was identified in the ileum. A diagnosis of type I EATL was made following histopathological examination. After eight courses of CHOP therapy, the patient entered complete remission. TCS and esophagogastroduodenoscopy with magnifying narrow-band imaging performed in 2015 identified villous regrowth in the distal ileum and duodenum. Capsule endoscopy also found villous regrowth in the entire small intestine. To our knowledge, this is the first case of type I EATL following CeD with villous atrophy before EATL occurrence in a Japanese HLA-DQ2 carrier. The possibility of type I EATL occurring after CeD should be recognized, although CeD is quite rare in Japan.
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Affiliation(s)
- Hiroto Hiraga
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hirotake Sakuraba
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Nahoko Tanaka
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Rina Watanabe
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yui Akemoto
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shinji Ota
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hidezumi Kikuchi
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Manabu Sawaya
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Noriko Hiraga
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Daisuke Chinda
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Norihiro Hanabata
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tatsuya Mikami
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tadashi Shimoyama
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takenori Takahata
- Department of Medical Oncology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Masanori Tanaka
- Department of Clinical Laboratory, Hirosaki Municipal Hospital, Hirosaki, Japan
| | - Shinsaku Fukuda
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Koay DSC, Ghumman A, Pu LZCT, Singh R. Narrow-band imaging with magnification and the water immersion technique: a case-finding, cost-effective approach to diagnose villous atrophy. Singapore Med J 2019; 60:522-525. [PMID: 31663101 PMCID: PMC6875824 DOI: 10.11622/smedj.2019131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Narrow-band imaging with magnification endoscopy (NBI-ME) allows real-time visual assessment of the mucosal surface and vasculature of the gastrointestinal tract. This study aimed to determine the performance of NBI-ME combined with the water immersion technique (NBI-ME-WIT) in detecting villous atrophy. METHODS All patients who underwent gastroscopy were included. The duodenum was further examined with NBI-ME-WIT only after examination with white light endoscopy did not reveal a cause of anaemia or dyspepsia. Targeted biopsies were taken of visualised areas. NBI-ME-WIT findings were compared with the final histopathological analysis. We calculated the sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of NBI-ME-WIT in detecting villous atrophy and the hypothetical cost saved by using a biopsy-avoiding approach. RESULTS 124 patients (83 female) with a mean age of 46 (range 18-82) years were included. The most common indication for gastroscopy was abdominal pain (39%), followed by anaemia (35%), chronic diarrhoea/altered bowel habits (19%) and dyspepsia (6%). NBI-ME-WIT was able to detect all nine patients with villous atrophy - eight patchy and one total villous atrophy. The Sn, Sp, PPV and NPV of NBI-ME-WIT in detecting villous atrophy were 100.0%, 99.1%, 90.0% and 100.0%, respectively. Taking into account the cost of biopsy forceps (AUD 17) and pathology (AUD 140), this biopsy-avoidance strategy could have saved AUD 18,055 in these patients. CONCLUSION NBI-ME-WIT is a specific and sensitive tool to recognise and accurately diagnose villous atrophy. Biopsies can be avoided in patients with normal-sized villi, which may decrease the overall cost of the procedure.
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Affiliation(s)
- Doreen Siew Ching Koay
- Gastroenterology Department, Lyell McEwin Hospital (Northern Adelaide Local Health Network), Australia
| | - Azhar Ghumman
- Gastroenterology Department, Lyell McEwin Hospital (Northern Adelaide Local Health Network), Australia
| | | | - Rajvinder Singh
- Gastroenterology Department, Lyell McEwin Hospital (Northern Adelaide Local Health Network), Australia
- School of Medicine, University of Adelaide, Australia
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10
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Tabibian JH, Perrault JF, Murray JA, Papadakis KA, Enders FT, Gostout CJ. Narrow band imaging evaluation of duodenal villi in patients with and without celiac disease: A prospective study. World J Gastrointest Endosc 2019; 11:145-154. [PMID: 30788033 PMCID: PMC6379743 DOI: 10.4253/wjge.v11.i2.145] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/09/2019] [Accepted: 01/26/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Duodenal biopsies are commonly obtained during esophagogastroduodenoscopy (EGD) but are very often histopathologically normal. Therefore, a more strategic method for evaluating the duodenal mucosa and avoiding unnecessary biopsies is needed. AIM To examine the clinical utility of narrow band imaging (NBI) for evaluating duodenal villous morphology. METHODS We performed a prospective cohort study of adult patients at Mayo Clinic Rochester from 2013-2014 who were referred for EGD with duodenal biopsies. A staff endoscopist scored, in real-time, the NBI-based appearance of duodenal villi into one of three categories (normal, partial villous atrophy, or complete villous atrophy), captured ≥ 2 representative duodenal NBI images, and obtained mucosal biopsies therein. Images were then scored by an advanced endoscopist and gastroenterology fellow, and biopsies (gold standard) by a pathologist, in a masked fashion using the same three-category classification. Performing endoscopist, advanced endoscopist, and fellow NBI scores were compared to histopathology to calculate performance characteristics [sensitivity, specificity, positive and negative, negative predictive value (NPV), and accuracy]. Inter-rater agreement was assessed with Cohen's kappa. RESULTS 112 patients were included. The most common referring indications were dyspepsia (47%), nausea (23%), and suspected celiac disease (14%). Duodenal histopathology scores were: 84% normal, 11% partial atrophy, and 5% complete atrophy. Performing endoscopist NBI scores were 79% normal, 14% partial atrophy, and 6% complete atrophy compared to 91%, 5%, and 4% and 70%, 24%, and 6% for advanced endoscopist and fellow, respectively. NBI performed favorably for all raters, with a notably high (92%-100%) NPV. NBI score agreement was best between performing endoscopist and fellow (κ = 0.65). CONCLUSION NBI facilitates accurate, non-invasive evaluation of duodenal villi. Its high NPV renders it especially useful for foregoing biopsies of histopathologically normal duodenal mucosa.
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Affiliation(s)
- James H Tabibian
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
- Division of Gastroenterology, Olive View-UCLA Medical Center, Sylmar, CA 91342, United States
| | - Jean F Perrault
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
| | - Joseph A Murray
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
| | | | - Felicity T Enders
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN 55905, United States
| | - Christopher J Gostout
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
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11
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Uchima H, Yao K. Endoscopic microanatomy of the normal gastrointestinal mucosa with narrow band technology and magnification. GASTROENTEROLOGIA Y HEPATOLOGIA 2018; 42:117-126. [PMID: 30471720 DOI: 10.1016/j.gastrohep.2018.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 06/16/2018] [Accepted: 10/01/2018] [Indexed: 01/03/2023]
Abstract
The development of high-definition endoscopes with optical zoom, along with the use of the digital chromoendoscopy and staining, has given endoscopists the possibility to study the microanatomy of the gastrointestinal mucosa in vivo. The recognition of the changes in the microstructure of the surface and microvascular architecture such as those that occur in neoplastic lesions allow us to characterize these lesions in order to decide on the best course of clinical action. The current greater availability of endoscopes with optical zoom in western countries has allowed the use of this technology in routine clinical practice to spread. In this article we review the basic concepts of magnifying endoscopy and the normal endoscopic microanatomy of the oesophageal, gastric, duodenal, ileal and colonic mucosa.
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Affiliation(s)
- Hugo Uchima
- Department of Endoscopy, Hospital Universitari Doctor Josep Trueta, Girona, Spain; Department of Endoscopy, Teknon Medical Center, Barcelona, Spain.
| | - Kenshi Yao
- Department of Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
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12
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Raju SA, White WL, Lau MS, Mooney PD, Rees MA, Burden M, Ciacci C, Sanders DS. A comparison study between Magniview and high definition white light endoscopy in detecting villous atrophy and coeliac disease: A single centre pilot study. Dig Liver Dis 2018; 50:920-924. [PMID: 29807874 DOI: 10.1016/j.dld.2018.03.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 03/28/2018] [Accepted: 03/30/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Coeliac disease may be missed at gastroscopy. We aimed to assess the sensitivity of Pentax optical zoom technology endoscopes in detecting duodenal villous atrophy and the ease of image interpretation by non-coeliac specialists. METHOD All patients attending for a gastroscopy were assessed for endoscopic villous atrophy in part one and two of the duodenum with high definition white light endoscopy and magnification endoscopy. Endoscopic findings of the duodenum were compared to histology as the reference standard. A short training video of varying degrees of villous atrophy seen by magnification endoscopy was used to train individuals. They were then assessed for the ability to differentiate between normal duodenum and villous atrophy. RESULTS Two hundred and fifty patients were prospectively recruited (145 females, 58%; age range 16-84, median age 50.5). Ninety-six patients had villous atrophy on histology (38.4%) 154 were controls. Magnification endoscopy had a higher sensitivity in detecting villous atrophy compared to high definition white light endoscopy (86.4% versus 78.4%, p = .0005). 9/10 individuals undertaking magnification endoscopy training correctly identified all cases of villous atrophy. CONCLUSION Magnification endoscopy has superior diagnostic sensitivity in detecting villous atrophy compared to high definition white light endoscopy and the potential to be easily adopted by all endoscopists.
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Affiliation(s)
- Suneil A Raju
- Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom.
| | - William L White
- Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Michelle S Lau
- Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Peter D Mooney
- Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Michael A Rees
- Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Mitchell Burden
- Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Carolina Ciacci
- Unit of Gastronterology, AOU San Giovannidi Dio e Ruggi D'Aragona, Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, Italy
| | - David S Sanders
- Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom
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Abstract
PURPOSE OF REVIEW The diagnostic approach in celiac disease is continuously evolving as our understanding of its pathophysiology improves. This review aims to provide a summary of contemporary work that supports optimization of the diagnosis of this common yet underdiagnosed condition. RECENT FINDINGS The recently updated National Institute of Clinical Excellence and European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines and the contentious biopsy-free diagnostic approach will be discussed. We will review the evidence advocating optimal biopsy techniques such as single bite biopsy and controversial bulb biopsy sampling to increase diagnostic yield. Recent data providing phenotypical characterization and clinical outcomes of celiac subtypes such as potential celiac disease, seronegative celiac disease and ultrashort celiac disease will be covered. We will present emerging evidence on novel case finding strategies with point of care tests. Promising novel markers for celiac disease such as serum intestinal fatty acid binding protein and in-vitro gluten challenge will be included. SUMMARY Recent work has demonstrated the clinical significance of the celiac disease subtypes, emphasizing the importance of careful diagnosis and recognition. There is a move toward a less invasive and perhaps more cost-effective diagnostic approach in celiac disease, but duodenal biopsy remains the gold standard at present for all adults and the majority of pediatric patients.
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High definition endoscopy with or without I-Scan increases the detection of celiac disease during routine endoscopy. Dig Liver Dis 2016; 48:644-9. [PMID: 26995214 DOI: 10.1016/j.dld.2016.02.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 01/27/2016] [Accepted: 02/18/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Celiac disease remains underdiagnosed at endoscopy. We aimed to assess the utility of I-Scan (virtual chromo-endoscopy) to improve sensitivity of endoscopy to detect markers of villous atrophy in this condition. METHODS Patients from 2 UK hospitals were studied in 3 groups. Group 1: standard high definition, white light endoscopy (WLE); Group 2: WLE plus I-Scan; Group 3: non-high definition control group. The presence of endoscopic markers was recorded. At least 4 duodenal biopsies were taken from all patients. Serology was performed concurrently and observations were compared with histology. RESULTS 758 patients (62% female, mean age 52) were recruited (Group 1: 230; Group 2: 228; Group 3: 300). 135 (17.8%) new diagnoses of coeliac disease were made (21 Group 1; 24 Group 2; 89 Group 3). The sensitivity for detection of endoscopic markers of villous atrophy was significantly higher in both Group 1 (85.7%, p=0.0004) and Group 2 (75%, p=0.005) compared to non-high definition controls (41.6%). There was no significant difference between high definition only and I-Scan groups (p=0.47). In non-high definition endoscopy a missed diagnosis was associated with lesser degrees of villous atrophy (p=0.019) and low tTG titre (p=0.007). CONCLUSIONS High definition endoscopy with or without I-Scan increases the detection of celiac disease during routine endoscopy.
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Dutta AK, Chacko A. Emerging role of narrow band imaging in duodenum. World J Gastrointest Endosc 2015; 7:1216-1221. [PMID: 26566428 PMCID: PMC4639743 DOI: 10.4253/wjge.v7.i16.1216] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 08/20/2015] [Accepted: 09/30/2015] [Indexed: 02/05/2023] Open
Abstract
Endoscopy using magnification narrow band imaging (mNBI) allows detailed assessment of mucosal surface and vascular pattern. This may help in better identification and prediction of the nature of the lesion. The role of this technology in duodenum is still evolving. Studies have shown that mNBI has high accuracy in predicting villous atrophy in the duodenum. Limited data suggests that this technique can provide additional information on duodenal polyps, nodules and ampullary tumour which can help guide their management. In this paper we describe the technique for duodenal assessment using NBI and review the existing literature evaluating its role in diagnosis of various duodenal pathologies.
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Cerquetella M, Spaterna A, Tesei B, Bassotti G, Rossi G. Blue-green endoscopy in a dog presenting chronic vomiting-regurgitation. Ir Vet J 2015; 68:17. [PMID: 26225208 PMCID: PMC4518603 DOI: 10.1186/s13620-015-0045-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 07/17/2015] [Indexed: 12/17/2022] Open
Abstract
A 2-year-old male Maremma sheepdog presenting with chronic vomiting-regurgitation was examined at the University Veterinary Teaching Hospital, Camerino University. An oesophagogastroscopy with a single blue + green (BG) filter restricting wavelengths from 400 to 550 nm was carried out. A conventional white light endoscopy showed a dilated oesophagus with mildly diffuse erythematous mucosa (more accentuated proximal to the cardia); some portions of the gastric mucosa were covered with fluids and appeared only slightly erythematous. A blue green endoscopy highlighted the oesophageal lesions in dark blue, which made them appear more clearly defined from the remaining mucosa. In the gastric antrum, a small, slightly darker blue roundish area was visible. This area did not show up under the white light endoscopy. A histopathological assessment of biopsy specimens from the distal oesophagus, antrum (including the area highlighted only by BG endoscopy) and gastric body showed chronic-active hyperplastic esophagitis and superficial squamous epithelial dysplasia, while gastric samples showed severe diffuse hyperaemic gastritis of the antrum and superficial diffuse atrophy of the gastric body. The authors believe that the use of a BG endoscopy could be useful in veterinary medicine to increase the diagnostic potential of endoscopic assessment in animals.
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Affiliation(s)
- Matteo Cerquetella
- />School of Biosciences and Veterinary Medicine, University of Camerino, Via Circonvallazione, 93/95 – 62024 Matelica (MC), Italy
| | - Andrea Spaterna
- />School of Biosciences and Veterinary Medicine, University of Camerino, Via Circonvallazione, 93/95 – 62024 Matelica (MC), Italy
| | - Beniamino Tesei
- />School of Biosciences and Veterinary Medicine, University of Camerino, Via Circonvallazione, 93/95 – 62024 Matelica (MC), Italy
| | - Gabrio Bassotti
- />Gastroenterology, Hepatology and Digestive Endoscopy Section, Department of Medicine, University of Perugia Medical School, Perugia, Italy
| | - Giacomo Rossi
- />School of Biosciences and Veterinary Medicine, University of Camerino, Via Circonvallazione, 93/95 – 62024 Matelica (MC), Italy
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Valitutti F, Oliva S, Iorfida D, Aloi M, Gatti S, Trovato CM, Montuori M, Tiberti A, Cucchiara S, Di Nardo G. Narrow band imaging combined with water immersion technique in the diagnosis of celiac disease. Dig Liver Dis 2014; 46:1099-1102. [PMID: 25224697 DOI: 10.1016/j.dld.2014.08.039] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 07/22/2014] [Accepted: 08/19/2014] [Indexed: 02/06/2023]
Abstract
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.
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Affiliation(s)
- Francesco Valitutti
- Pediatric Gastroenterology and Liver Unit, Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | - Salvatore Oliva
- Pediatric Gastroenterology and Liver Unit, Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | - Donatella Iorfida
- Pediatric Gastroenterology and Liver Unit, Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | - Marina Aloi
- Pediatric Gastroenterology and Liver Unit, Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | - Silvia Gatti
- Pediatric Gastroenterology and Liver Unit, Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | - Chiara Maria Trovato
- Pediatric Gastroenterology and Liver Unit, Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | - Monica Montuori
- Pediatric Gastroenterology and Liver Unit, Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | - Antonio Tiberti
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Salvatore Cucchiara
- Pediatric Gastroenterology and Liver Unit, Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | - Giovanni Di Nardo
- Pediatric Gastroenterology and Liver Unit, Department of Pediatrics, Sapienza University of Rome, Rome, Italy.
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Petrarca L, Nenna R, Mastrogiorgio G, Florio M, Brighi M, Pontone S. Dyspepsia and celiac disease: Prevalence, diagnostic tools and therapy. World J Methodol 2014; 4:189-196. [PMID: 25332916 PMCID: PMC4202456 DOI: 10.5662/wjm.v4.i3.189] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 06/17/2014] [Accepted: 09/10/2014] [Indexed: 02/06/2023] Open
Abstract
The prevalence of dyspepsia is up to 40% in population-based study. Functional dyspepsia is an exclusion diagnosis and it is classified as a chronic abdominal pain-related functional disorder, characterized by the presence of persistent or recurrent pain or discomfort centered in the upper abdomen, neither relief by defecation, nor association with the onset of a change in stool frequency or form. Celiac disease (CD) is a common autoimmune enteropathy, with a prevalence around 1% in the general population. Its diagnosis includes a serological screening and an upper gastrointestinal endoscopy with multiple biopsies. Gluten-free diet is the only effective treatment. CD diagnosis is often delayed in asymptomatic patients or in individuals with less clinical gastrointestinal symptoms. Several studies performed coeliac disease screening in patients with symptoms suggestive of dyspepsia, showing a biopsy-proved prevalence that ranged from 0.5% to 2%. The typical endoscopic markers of villous atrophy are not sufficiently sensitive, so some endoscopic techniques, such as “water immersion” and confocal endomicroscopy were proposed to improve the diagnostic sensitivity and target biopsies. A recent meta-analysis estimated that the prevalence of CD was higher in patients with dyspepsia, but not in a statistically significant way. However this assumption should be confirmed further larger studies.
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Use of narrow band imaging in assessing duodenal villous atrophy. Indian J Gastroenterol 2014; 33:440-4. [PMID: 25015746 DOI: 10.1007/s12664-014-0489-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 06/30/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVE Narrow band imaging endoscopy with magnification (NBI-ME) has already been established in Barrett's esophagus, stomach, and colonic mucosa, but limited work has been done in the mucosal evaluation of duodenum. A study was done to determine the correlation between NBI and histology in grading villous architecture in varied etiology. METHOD A prospective observational study comprising 105 subjects with suspected malabsorption. The presence of a diagnosed celiac disease, severe life threatening comorbidity, or pregnancy was considered as exclusion criteria. Standard endoscopy (SE), NBI-ME, multiple duodenal biopsies with histopathological examination were done in all. RESULTS Fifty-one patients had celiac disease while 54 patients comprised mainly functional dyspepsia, iron deficiency anemia, tropical malabsorption syndrome, and irritable bowel syndrome. Four NBI-ME image subtypes of villous morphology have been proposed (NBI type I/II/III/IV). NBI-ME had 95 % sensitivity, 90.2 % specificity, 91.2 % positive predictive value, and 94.2 % negative predictive value for diagnosing altered villous morphology. Intraobserver kappa agreement coefficient (κ) for NBI-ME was 0.83 while interobserver agreement was 0.89 (95 % CI 0.8-0.97). CONCLUSION NBI-ME has good performance characteristics and very good kappa intra/interobserver agreement coefficient for varied subtypes of villous morphology. NBI-ME is most useful for obtaining a targeted biopsy which can be missed by conventional white light endoscopy.
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Dutta AK. Narrow band imaging endoscopy for real-time assessment of duodenal villi. Indian J Gastroenterol 2014; 33:408-9. [PMID: 25002074 DOI: 10.1007/s12664-014-0486-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 06/14/2014] [Indexed: 02/04/2023]
Affiliation(s)
- Amit Kumar Dutta
- Department of Gastroenterology, Christian Medical College, Vellore, 632 004, India,
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