The 'immersion' technique during upper endoscopy allows the visualization of duodenal villi and the detection of total villous atrophy.
Dr Cammarota and colleagues from Italy evaluated the accuracy of the immersion technique in detecting total villous atrophy in celiac patients.
The team also analyzed the accuracy in diagnosing celiac disease and the potential cost-sparing of a biopsy-avoiding approach.
The biopsy-avoiding approach was based on selection of individuals with celiac disease-related antibodies and on endoscopic detection of absence of villi.
The immersion technique was performed in 79 patients with positive antibodies and in 105 controls.
|Biopsy specificity in diagnosing celiac disease when villi were absent was always 100%|
|Alimentary Pharmacology & Therapeutics|
Duodenal villi were evaluated as present or absent.
As reference, the researchers compared results with histology.
Diagnostic approaches, including endoscopy, were designed to investigate patients with celiac disease-related antibodies and total villous atrophy.
The research team also performed a cost-minimization analysis.
The researchers noted that all patients with positive antibodies had celiac disease.
The sensitivity, specificity, positive and negative predictive values of endoscopy to detect total villous atrophy was always 100%.
The team observed that sensitivity, and specificity of biopsy-avoiding or biopsy-including strategies in diagnosing celiac disease when villi were absent was always 100%.
Positive and negative predictive values of biopsy-avoiding or biopsy-including strategies in diagnosing celiac disease when villi were absent was always 100%.
The researchers noted that the biopsy-avoiding strategy was cost-sparing.
Dr Cammarota's team concluded, “Upper endoscopy is highly accurate in detecting total villous atrophy celiac patients.”
“A biopsy-avoiding approach is both accurate and cost-sparing to diagnose celiac disease in subjects with marked duodenal villous atrophy.”