Endocytoscopy for the detection of microstructural features in adult patients with celiac sprue: a prospective, blinded endocytoscopy-conventional histology correlation study.

BACKGROUND: Endocytoscopy (EC) is a novel technique that allows magnified live inspection of the intestinal mucosa.

OBJECTIVE: To evaluate EC for the detection of key pathological findings in patients with celiac sprue.

DESIGN: A total of 166 EC recordings were prospectively acquired. Matched videos, images, and biopsy specimens were obtained by duodenal argon beamer labeling of the respective sites.

SETTING: Academic tertiary referral center.

PATIENTS: Forty patients (mean age 51.5 years, 70% women) with established (n = 32) or suspected (n = 8) celiac disease (CD).

INTERVENTIONS: A validated scoring system (Marsh classification) was used to assess disease activity. EC criteria were independently evaluated by 2 gastroenterologists and 1 pathologist.

MAIN OUTCOME MEASUREMENTS: The primary endpoint was to examine EC correlation with conventional CD histology.

RESULTS: Of 166 duodenal biopsy sites, 23% were classified as Marsh III (moderate to severe), 10% as Marsh I (mild), and 67% as Marsh 0 (normal). Using the 450x magnification, we found that identification of crypts was diagnostic for celiac pathology. Four criteria were significant predictors of Marsh III pathology when adjusted by multivariate analysis: low number of villi per visual field (<3; odds ratio [OR] 9.1; 95% CI, 1.3-62.0), confluence of villi (OR 37.1; 95% CI, 1.3-1021.2), irregular epithelial lining (OR 10.9; 95% CI, 2.5-46.7), and inability to delineate loop capillaries (OR 14.9; 95% CI, 3.3-67.0). None was a good predictor of Marsh I pathology.

LIMITATIONS: Single-center experience. No prospective validation of the criteria in an independent patient population.

CONCLUSIONS: EC at 450x magnification accurately identifies mucosal histopathology of advanced CD, but not early morphological changes.