Endocytoscopy for the detection of microstructural features in adult patients with celiac sprue: a prospective, blinded endocytoscopy-conventional histology correlation study.

BACKGROUND: Endocytoscopy (EC) is a novel technique that allows magnified live inspection of the intestinal mucosa. OBJECTIVE: To evaluate EC for the detection of key pathological findings in patients with celiac sprue. DESIGN: A total of 166 EC recordings were prospectively acquired. Matched videos, images, and biopsy specimens were obtained by duodenal argon beamer labeling of the respective sites. SETTING: Academic tertiary referral center. PATIENTS: Forty patients (mean age 51.5 years, 70% women) with established (n = 32) or suspected (n = 8) celiac disease (CD). INTERVENTIONS: A validated scoring system (Marsh classification) was used to assess disease activity. EC criteria were independently evaluated by 2 gastroenterologists and 1 pathologist. MAIN OUTCOME MEASUREMENTS: The primary endpoint was to examine EC correlation with conventional CD histology. RESULTS: Of 166 duodenal biopsy sites, 23% were classified as Marsh III (moderate to severe), 10% as Marsh I (mild), and 67% as Marsh 0 (normal). Using the 450x magnification, we found that identification of crypts was diagnostic for celiac pathology. Four criteria were significant predictors of Marsh III pathology when adjusted by multivariate analysis: low number of villi per visual field (