Utility of narrow band imaging in predicting histology in celiac disease
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ORIGINAL ARTICLE
Utility of narrow band imaging in predicting histology in celiac disease Saroj Kant Sinha 1 & Neha Berry 1 & Gaurav Muktesh 1 & Pradeep Siddappa 1 & Jahangeer Basha 1 & Kaushal Prasad 1 & Sreekanth Appasani 1 & Munish Ashat 1 & Kim Vaiphei 2 & Kartar Singh 1 & Rakesh Kochhar 1 Received: 8 October 2019 / Accepted: 24 March 2020 # Indian Society of Gastroenterology 2020
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. Keywords Endoscopy . Narrow band imaging . Tissue transglutaminase antibody . Villous atrophy . Malabsorption syndrome . Gluten . Wheat . Enteropathy . Chronic diarrhea . Sprue . Marsh classification
* Rakesh Kochhar [email protected] 1
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India
2
Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India
Indian J Gastroenterol
Bullet points of the study highlights What is already known? Celiac disease (CD) causes atrophy of villous architecture. Biopsy from duodenum is gold standard for diagnosis of CD. Patchiness of duodenal atrophy in CD may result in missed diagnosis if biopsies are not taken from affected mucosa. What is new in this study? Narrow band imaging (NBI) can be useful in deciphering the duodenal architecture. NBI by detecting the areas of duodenal atrophy may be useful in helping guided biopsies. NBI in association with IgA tTG titers has high sensitivity and specificity in diagnosis of villous atrophy. What are the future clinical and research implications of the study findings
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