Please use this identifier to cite or link to this item:
Scopus Web of Science® Altmetric
Type: Journal article
Title: In vivo confocal endomicroscopy in the diagnosis and evaluation of celiac disease
Author: Leong, R.
Nguyen, Q.
Meredith, C.
Al-Sohaily, S.
Kukic, D.
Delaney, P.
Murr, E.
Yong, J.
Merrett, N.
Biakin, A.
Citation: Gastroenterology, 2008; 135(6):1870-1876
Publisher: W B Saunders Co
Issue Date: 2008
ISSN: 0016-5085
Statement of
Rupert W.L. Leong, Nam Q. Nguyen, Christopher G. Meredith, Sam Al–Sohaily, Darko Kukic, Peter M. Delaney, Elise R. Murr, Jim Yong, Neil D. Merrett and Andrew V. Biankin
Abstract: Background & Aims Accurate histopathology of endoscopic duodenal biopsy specimens is critical in the diagnosis of celiac disease (CD) but sampling error and poor quality specimens may generate a false-negative result. Confocal endomicroscopy (CEM) is a novel technology allowing real-time in vivo microscopy of the mucosa that may diagnose CD and evaluate its severity and response to treatment more accurately than histopathology. Methods Subjects with CD and controls prospectively underwent CEM. Features of villous atrophy and crypt hypertrophy were defined. A CEM score measuring CD severity was devised and validated against the diagnosis of CD and blinded histopathology. Receiver operator characteristics, sensitivity to change after treatment, and reliability of findings were assessed. Results From 31 patients (6 untreated CD, 11 treated CD, and 14 controls), 7019 CEM images paired with 326 biopsy specimens were obtained. The accuracy of CEM in diagnosing CD was excellent (receiver operator characteristics area under the curve, 0.946; sensitivity, 94%, specificity, 92%) and correlated well with the Marsh grading (R-squared, 0.756). CEM differentiated CD from controls (P < .0001) and was sensitive to change after treatment with gluten-free diet (1787 optical biopsies; P = .012). The intraclass correlation of reliability was high (0.759–0.916). Of the 17 cases with diagnosed CD, 16 (94%) were diagnosed correctly using CEM but only 13 (76%) had detectable histopathology changes. The procedure was safe and well-tolerated. Conclusions CEM effectively diagnoses and evaluates CD severity in vivo. This promising technique has the potential to improve endoscopy efficiency.
Keywords: CCS, confocal celiac score; CD, celiac disease; CEM, confocal endomicroscopy; CH, crypt hypertrophy; D1 to D4, first to fourth parts of the duodenum; GFD, gluten-free diet; ROC, receiver operating characteristic; VA, villous atrophy
Description: Copyright © 2008 AGA Institute Published by Elsevier Inc.
RMID: 0020084665
DOI: 10.1053/j.gastro.2008.08.054
Appears in Collections:Medicine publications

Files in This Item:
There are no files associated with this item.

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.