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  • Review Article
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Emerging technologies in upper gastrointestinal endoscopy and celiac disease

Nature Clinical Practice Gastroenterology & Hepatology volume 6, pages 47–56 (2009)Cite this article

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.

Key Points

  • The gold standard for the diagnosis of celiac disease is the histological demonstration of characteristic pathological changes of the duodenal mucosa

  • The role of endoscopy is at present limited to obtaining a number of duodenal biopsies because of its low accuracy in predicting histological changes

  • Newly developed technologies in the field of gastrointestinal endoscopy make possible the real-time recognition of the duodenal villous pattern during upper endoscopy

  • Further investigations are needed to confirm encouraging preliminary reports of the use of newly developed endoscopic techniques in the diagnosis of celiac disease

  • The water-immersion technique, magnification endoscopy, optical band imaging, optical coherence tomography and confocal endomicroscopy demonstrate potential to have a more incisive role in the diagnosis of celiac disease

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Figure 1: Visualization of duodenal mucosa by standard upper endoscopy in combination with the water-immersion technique.
Figure 2: Visualization of duodenal mucosa by high-resolution magnification endoscopy in combination with the water-immersion technique.
Figure 3: Visualization of duodenal mucosa by optimal band imaging magnification endoscopy.
Figure 4: Proposed algorithm to minimize the need for duodenal biopsy in patients with suspected celiac disease.

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Acknowledgements

Some of the material discussed in this Review is based on work supported in part by funds from the Italian Ministry for University, Scientific, and Technological Research.

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Authors and Affiliations

  1. G Cammarota is Assistant Professor in the Department of Medicine at the A Gemelli Hospital and Catholic University of Medicine and Surgery, P Fedeli is Attending Physician in the Department of Gastroenterology at the S Spirito Hospital, and A Gasbarrini is Associate Professor of Internal Medicine at the Catholic University of Medicine and Surgery, Rome, Italy.,

    Giovanni Cammarota, Paolo Fedeli & Antonio Gasbarrini

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  1. Giovanni Cammarota
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Correspondence to Giovanni Cammarota.

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Cammarota, G., Fedeli, P. & Gasbarrini, A. Emerging technologies in upper gastrointestinal endoscopy and celiac disease. Nat Rev Gastroenterol Hepatol 6, 47–56 (2009). https://doi.org/10.1038/ncpgasthep1298

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