Background and aims: Severe villous atrophy can be revealed with conventional white light endoscopy (WLE),
however, milder grades or patchy villous atrophy are more difficult to detect. Novel
endoscopic techniques such as high definition i-SCAN endoscopy with the water immersion
technique (i-SCAN-HDWI) may provide the ability to visualize duodenal villi more accurately.
We aimed to determine the performance of i-SCAN-HDWI in evaluating the severity of
histological damage in the duodenum of patients with celiac disease.
Patients and methods: A retrospective cohort study was performed in a single tertiary academic endoscopic
center. We studied 58 patients (46 women; median age 36.5 years, range 18 – 72 years)
with positive anti-TTG IgA antibody. The villous pattern of the second part of the
duodenum was assessed by WLE and i-SCAN-HDWI. The endoscopic grades in both techniques
were correlated using Marsh histologic grades by Spearman correlation coefficient.
The diagnostic accuracy of i-SCAN-HDWI for detection of patchy or complete atrophy
of the villi was evaluated.
Results: A significant correlation was demonstrated between endoscopic grade using i-SCAN-HDWI
and Marsh histologic grade (r = 0.732; P < 0.00001). The correlation between WLE grade and Marsh histologic grade was inferior
to i-SCAN-HDWI (r = 0.31; P = 0.01). The sensitivity of i-SCAN-HDWI was 96 % (95 %CI: 85 – 99 %) and the specificity
was 63 % (95 %CI: 26 – 90 %) in diagnosing abnormal biopsy consistent with celiac
disease.
Conclusion: i-SCAN-HDWI endoscopy can reflect the histological severity of celiac disease more
accurately than conventional WLE alone. This novel endoscopic imaging can improve
the diagnostic yield of duodenal biopsies in celiac patients, especially for those
with a patchy distribution of villous damage.
