Probe-Based Confocal Laser Microscopy Identifies Criteria Predictive of Active Celiac Sprue
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Celiac sprue is an underdiagnosed chronic intestinal inflammatory disease. Probe-based confocal laser microscopy (CLM) is a novel endoscopic technique for in vivo inspection of the intestinal mucosa that has not been evaluated in celiac sprue yet.
To develop CLM criteria most predictive of celiac pathology in a prospective pilot study.
Twenty-one patients (male n = 5, f = 16, mean age 52 years) with established or suspected celiac sprue, seven of whom had confirmed active disease (Marsh III) and 14 duodenal normal mucosa. CLM images from 91 duodenal sites were assessed. CLM recordings were obtained next to Argon beamer labeled areas. Biopsies were taken from the same spots for precise histological matching. After establishing histology-correlated criteria on one sample per patient, the remaining CLM recordings from the same patients were randomized and blindly evaluated.
Villous atrophy and irregular appearing villi were most predictive of celiac pathology. Although the presence of crypts was diagnostic for celiac pathology, it was only recognized in 26.7% of celiac pathology sites. Using these criteria in the blinded assessment, the overall endoscopist’s prediction of celiac sprue was accurate in 89.8% of all biopsy sites in 85.7% of all patients. Preliminary interobserver agreement testing villous atrophy, irregular villi, and crypts was poor (kappa 0.05 to 0.26).
Probe-based CLM criteria developed in this pilot trial appear promising for the detection of active celiac sprue. Preliminary interobserver variability was high, indicating a learning curve effect. Our criteria need validation in an independent patient population.
KeywordsCeliac sprue Endoscopy Endomicroscopy Confocal laser scanning microscopy CLM Microscopy
Conflict of interest
The CLM prototype system was kindly provided as an unrestricted research grant by the manufacturer (Mauna Kea Technologies, Paris, France). The manufacturer had no role in the design, conduction, analysis, and interpretation of the data of this study. No financial conflicts of interest exist.
- 14.van den Broek FJ, Fockens P, van ES, Reitsma JB, Hardwick JC, Stokkers PC, Dekker E: Endoscopic tri-modal imaging for surveillance in ulcerative colitis: randomized comparison of high resolution endoscopy and autofluorescence imaging for neoplasia detection; and evaluation of narrow band imaging for classification of lesions. Gut 2008.Google Scholar
- 15.Pohl H, Rosch T, Tanczos BT, Rudolph B, Schluns K, Baumgart DC. Endocytoscopy for the detection of microstructural features in adult patients with celiac sprue: a prospective, blinded endocytoscopy-conventional histology correlation study. Gastrointest Endosc. 2009;70:933–941.PubMedCrossRefGoogle Scholar
- 23.Trovato C, Sonzogni A, Ravizza D, Pruneri G, Rossi M, de RG, Tamayo D, Vanazzi A, Fiori G, Crosta C. Confocal laser endomicroscopy diagnosis of gastric adenocarcinoma in a patient treated for gastric diffuse large-B-cell lymphoma. Dig Liver Dis 2008.Google Scholar