Optimal band imaging system: a new tool for enhancing the duodenal villous pattern in celiac disease
Department of Internal Medicine, Endoscopy Unit, Catholic University of Medicine and Surgery, Rome, Italy. Gastrointestinal endoscopy
(Impact Factor: 5.37).
07/2008; 68(2):352-7. DOI: 10.1016/j.gie.2008.02.054
The optimal band imaging (OBI) system is a new technology that can select better spectral images decomposed from ordinary endoscopic images. This technology, first introduced as "FUJI Intelligent Color Enhancement," enhances the contrast of the mucosal surface without the use of dyes.
This study aimed to evaluate the potential of OBI for predicting the duodenal villous morphologic characteristics in patients with suspected celiac disease.
This study was designed as an open, prospective, single-center trial. Duodenoscopy was performed with a high-resolution magnification view, in association with OBI spectral processing. Duodenal villous patterns were evaluated and classified as normal, partially atrophic, or markedly atrophic. The endoscopic results were then compared with the histologic diagnosis.
Endoscopy unit at the A. Gemelli University Hospital of Rome, Italy.
Sixty-one patients undergoing upper endoscopy for clinical history of malabsorption or serologic suspicion for celiac disease were included in the study.
From OBI sets using red, green, and blue wavelength combinations that ranged from 400 to 580 nm, the endoscopist was able to find marked villous atrophy of the duodenum in 16 subjects, partial villous atrophy in 9 subjects, and normal villi in the remaining 36 subjects. The sensitivity, specificity, and positive and negative predictive values of the OBI-based duodenoscopy were 100% accurate in the evaluation of villous patterns.
High-resolution magnification endoscopy with OBI allows clear visualization of the duodenal villous pattern. The OBI system may play a potential role in optimizing the diagnostic accuracy of endoscopy in celiac disease.
Available from: Marco Rocchi
- "through the ability to select better spectral images decomposed from ordinary endoscopic images . Cammarota et al.  published an original open, prospective, singlecentre trial on the potential of a similar system, the optimal band imaging (OBI), for predicting the duodenal villous morphologic characteristics in patients with suspected CD. The authors concluded that the OBI system, in association with ME, allows clear visualization of the duodenal pattern, with a potential role in optimizing the diagnostic accuracy of endoscopy in CD. "
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ABSTRACT: In celiac disease (CD), the intestinal lesions can be patchy and partial villous atrophy may elude detection at standard endoscopy (SE). Narrow Band Imaging (NBI) system in combination with a magnifying endoscope (ME) is a simple tool able to obtain targeted biopsy specimens. The aim of the study was to assess the correlation between NBI-ME and histology in CD diagnosis and to compare diagnostic accuracy between NBI-ME and SE in detecting villous abnormalities in CD. Forty-four consecutive patients with suspected CD undergoing upper gastrointestinal endoscopy have been prospectively evaluated. Utilizing both SE and NBI-ME, observed surface patterns were compared with histological results obtained from biopsy specimens using the k-Cohen agreement coefficient. NBI-ME identified partial villous atrophy in 12 patients in whom SE was normal, with sensitivity, specificity, and accuracy of 100%, 92.6%, and 95%, respectively. The overall agreement between NBI-ME and histology was significantly higher when compared with SE and histology (kappa score: 0.90 versus 0.46;
) in diagnosing CD. NBI-ME could help identify partial mucosal atrophy in the routine endoscopic practice, potentially reducing the need for blind biopsies. NBI-ME was superior to SE and can reliably predict
the villous changes of CD.
Available from: Giovanni Cammarota
- "Correspondence *Department of Internal Medicine, Unit of Endoscopy, A Gemelli University Hospital of Rome, Largo A Gemelli 8, 1-00168 Rome, Italy firstname.lastname@example.org Received 28 June 2008 Accepted 6 October 2008 Published online 11 November 2008 www.nature.com/clinicalpractice doi:10.1038/ncpgasthep1298"
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ABSTRACT: Despite advances in our knowledge of celiac disease, the most current and authoritative recommendations conclude that diagnosis requires at least four biopsy specimens to be taken from the duodenal area. These recommendations are based on the perception that classic endoscopic markers are not adequate to target biopsy sampling to sites of villous damage in the duodenum. In the past few years, newly developed procedures and technologies have improved endoscopic recognition of the duodenum. These advances make possible the real-time recognition of the duodenal villous pattern during an upper endoscopy procedure, and thereby have the potential to optimize diagnostic accuracy. It is, therefore, reasonable to hypothesize that upper endoscopy might have a more incisive role in the diagnosis of celiac disease than merely providing a means of obtaining biopsy specimens for histological analysis. This Review highlights the new technologies in the field of upper endoscopy that could be helpful for the diagnosis of celiac disease, including the water-immersion technique, chromoendoscopy, high-resolution magnification endoscopy, optimal band imaging, optical coherence tomography and confocal endomicroscopy.
Available from: scielo.br
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ABSTRACT: Celiac disease (CD) is found in genetically predisposed individuals, and characterized by an intolerance to ingestion of gluten, contained in cereals such as barley, rye, wheat and malt. Clinical manifestations of CD vary from asymptomatic patients to severe forms of malabsorption syndromes, which may involve multiple systems and increase the risk of some malignancies. Diagnosis of CD requires a high degree of suspicion. There is no single test for the diagnosis, which is reached after a combination of clinical and laboratory data. The first step for diagnosis is a serum test such as tissue antitransglutaminase, antibodies or antiendomisio. If serum result is positive, prompt duodenal biopsy is necessary for diagnostic confirmation. An IgA deficiency, which occurs in 3% of patients with DC, may lead to false-negatives because serology is based on IgA. Another situation of false-negative tests is diet restriction of gluten; therefore diagnostic investigation must be carried out during a diet containing gluten. The screening for CD in asymptomatic individuals is not indicated.
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