Endoscopic tools for the diagnosis and evaluation of celiac disease

Abstract

Celiac disease (CD) is an autoimmune disease of the small bowel induced by ingestion of wheat, rye and barley. Current guidelines indicate histological analysis on at least four duodenal biopsies as the only way to diagnose CD. These indications are based on the conception of the inability of standard endoscopy to make diagnosis of CD and/or to drive biopsy sampling. Over the last years, technology development of endoscopic devices has greatly ameliorated the accuracy of macroscopic evaluation of duodenal villous pattern, increasing the diagnostic power of endoscopy of CD. The aim of this paper is to review the new endoscopic tools and procedures proved to be useful in the diagnosis of CD, such as chromoendoscopy, Fujinon Intelligent Chromo Endoscopy, Narrow Band Imaging, Optical Coherence Tomography, Water-Immersion Technique, confocal laser endomicroscopy, high-resolution magnification endoscopy, capsule endoscopy and I-Scan technology.

Keywords: Capsule endoscopy; Celiac disease; Chromoendoscopy; Confocal laser endomicroscopy; Diagnostic techniques and procedures; Duodenum; Endoscopy; Fujinon intelligent chromo endoscopy; High-resolution magnification endoscopy; I-scan technology; Malabsorption syndrome; Narrow band imaging; Optical coherence tomography; Water-immersion technique.

Figure 1

Histological appearance respectively. A: Normal duodenal pattern; B: Celiac disease.

Figure 2

Evaluation of duodenal villous pattern with the water-immersion technique, Fujinon intelligent chromo endoscopy system, capsule endoscopy, I-scan technology. A: Presence of villi with the water-immersion technique; B: Total villous atrophy with the water-immersion technique; C: Presence of villi with Fujinon intelligent chromo endoscopy (FICE) system; D: Total villous atrophy with FICE system; E: Presence of villi with capsule endoscopy; F: Total villous atrophy with capsule endoscopy; G: Duodenal villous pattern with I-scan technology.