Narrow-band imaging in the evaluation of villous morphology: a feasibility study assessing a simplified classification and observer agreement

Singh, Rajvinder; Nind, Garry; Tucker, Graeme; Nguyen, Nam Q.; Holloway, Richard H.; Bate, John P.; Shetti, Mohit P; George, Biju; Tam, Wayne

doi:10.1055/s-0030-1255708

Cited by 39 publications

(33 citation statements)

References 13 publications

(16 reference statements)

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“…A few previously published studies have shown similar results [6,7,10]. Table 1 shows the results of these studies along with data from the current study.…”

supporting

confidence: 78%

“…The authors have classified the appearance of duodenal villi on magnification NBI into four categories, although this lacked external validation as the authors have mentioned. The appearance of duodenum on NBI endoscopy in patients with normal villi, partially atrophic villi, and completely atrophic villi has been already described in previous studies, and the current study does not provide any additional features for observation [6,7]. However, results from this study are a welcome addition to the data on the usefulness of NBI in duodenal disease.…”

supporting

confidence: 70%

“…In contrast, relatively little data is available on its utility in assessing duodenal pathology. This technology has been reported to be helpful in assessing ampullary lesions and detecting villous atrophy in the duodenum [5][6][7][8].The study by Goswami et al published in the current issue of this Journal [9] assesses the role of NBI in predicting duodenal villous morphology. They prospectively enrolled 105 patients with suspected malabsorption and compared the observations made on duodenal villous morphology during NBI endoscopy with histopathology findings.…”

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confidence: 99%

mentioning

confidence: 99%

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Narrow band imaging endoscopy for real-time assessment of duodenal villi

Dutta

2014

Indian J Gastroenterol

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The technology of narrow band imaging (NBI) has been available commercially for about a decade. The NBI filter allows only blue and green wavelength of light to pass through and this gives blood vessels a dark appearance [1]. This, along with image magnification and the use of a high definition monitor, allows detailed assessment of the microsurface and microvascularity of the mucosal surface. Accordingly, the information obtained during NBI endoscopy is much more than during conventional white light endoscopy [2]. In the duodenum, villi are clearly seen during magnification NBI endoscopy. Most studies on NBI in the gastrointestinal tract have focussed on the esophagus and colon especially for the evaluation of Barrett's esophagus and detection of colorectal polyps [3,4]. In contrast, relatively little data is available on its utility in assessing duodenal pathology. This technology has been reported to be helpful in assessing ampullary lesions and detecting villous atrophy in the duodenum [5][6][7][8].The study by Goswami et al. published in the current issue of this Journal [9] assesses the role of NBI in predicting duodenal villous morphology. They prospectively enrolled 105 patients with suspected malabsorption and compared the observations made on duodenal villous morphology during NBI endoscopy with histopathology findings. Interestingly, 59 patients had celiac disease or tropical malabsorption and only 1 patient had irritable bowel syndrome (IBS). As chronic diarrhea was one of the inclusion criteria, one would have expected more IBS patients in the study population. Fiftyeight patients had villous atrophy on histology and magnification NBI imaging had 95 % sensitivity and 90.2 % specificity in detecting villous atrophy when interpreted by the person performing the procedure. The endoscopy images were also assessed by another person and they found good interobserver agreement with the primary assessor. The authors have classified the appearance of duodenal villi on magnification NBI into four categories, although this lacked external validation as the authors have mentioned. The appearance of duodenum on NBI endoscopy in patients with normal villi, partially atrophic villi, and completely atrophic villi has been already described in previous studies, and the current study does not provide any additional features for observation [6,7]. However, results from this study are a welcome addition to the data on the usefulness of NBI in duodenal disease.The findings from this study are encouraging and indicate that NBI has a potential role in detecting villous atrophy. A few previously published studies have shown similar results [6,7,10]. Table 1 shows the results of these studies along with data from the current study. All of them show very good sensitivity and specificity of magnification NBI in detecting duodenal villous atrophy. Normal duodenal villi appear finger or leaf-shaped while abnormal villi appear short and stubbed or gyrate or are completely absent. In a clinical setting, this would potentially hel...

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“…A few previously published studies have shown similar results [6,7,10]. Table 1 shows the results of these studies along with data from the current study.…”

supporting

confidence: 78%

supporting

confidence: 70%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Narrow band imaging endoscopy for real-time assessment of duodenal villi

Dutta

2014

Indian J Gastroenterol

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“…Indeed, endoscopic imaging has been applied to numerous studies of coeliac disease, which exhibits similar but more extreme changes in intestinal structure to EED, including scalloped duodenal folds, grooves, fissurations and loss of the finger-shaped villi that cover the healthy mucosal surface 23 . The contrast of the villous structure can be enhanced through techniques including water immersion 24 , high-definition (HD) endoscopy 25 , chromoendoscopy 26 , narrow band imaging (NBI) 27 , and other forms of optical or digital chromoendoscopy such as optimal band imaging (OBI) 28 , providing sensitivities and specificities of up to 100% for villous atrophy 25 . FIGURE 2a-d shows the contrast improvement offered by optical chromoendoscopy, revealing clear differences between healthy and unhealthy villous mucosa.…”

Section: Biomarkers For Eedmentioning

confidence: 99%

The potential role of optical biopsy in the study and diagnosis of environmental enteric dysfunction

Thompson

Hughes

Anastasova

et al. 2017

Nat Rev Gastroenterol Hepatol

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| Environmental enteric dysfunction (EED) is a disease of the small intestine affecting children and adults in low and middle income countries. Arising as a consequence of repeated infections, gut inflammation results in impaired intestinal absorptive and barrier function, leading to poor nutrient uptake and ultimately to stunting and other developmental limitations. Progress towards new biomarkers and interventions for EED is hampered by the practical and ethical difficulties of cross-validation with the gold standard of biopsy and histology. Optical biopsy techniques -which can provide minimally invasive or noninvasive alternatives to biopsy -could offer other routes to validation and could potentially be used as point-of-care tests among the general population. This Consensus Statement identifies and reviews the most promising candidate optical biopsy technologies for applications in EED, critically assesses them against criteria identified for successful deployment in developing world settings, and proposes further lines of enquiry. Importantly, many of the techniques discussed could also be adapted to monitor the impaired intestinal barrier in other settings such as IBD, autoimmune enteropathies, coeliac disease, graft-versus-host disease, small intestinal transplantation or critical care. Members of the board and experts met to discuss the horizon scan in London, UK, in November 2015 and San Francisco, USA, in February 2016. Literature searches were performed using Web of Science, as well as through the advice of the advisory board and experts. The results of the horizon scan are presented in this Consensus Statement, which entails a review of EED, a discussion of technologies deemed relevant to EED (based on literature searches and the opinions of the advisory board and experts), and a series of recommendations for the future application of the rele vant technologies to the study and diagnosis of EED. In the Recommendations section, each technology has been assessed according to its suitability for application to EED and this assessment includes an evaluation of the cost, invasiveness and appropriateness for developing countries of each device and/or technique. This assessment was performed in a qualitative manner based on currently available information (for example, the present cost and size of the devices) and the opinions of the authors as to feasible future develop ment. Technique suitability for use in developing countries was determined in a qualitative manner after consideration of the need for advanced infrastructure and high levels of training for either system use or data analysis. Probable deployment time scales have also been assigned to each technique based on the current states of development and the degree of valid ation work that will be required before application to EED. These timescales have been tentatively defined as short-term (suitable for deployment immediately or within ~1 year), mediumterm (suit able for deployment within ~1-3 years) and long-term (suitable for deployme...

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Value of routine duodenal mucosal biopsies in the evaluation of anemia in a large Australian referral centre

2018

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Background and AimSmall bowel mucosal biopsies (SBBx) are routinely performed to investigate unexplained anemia; however, previous studies have demonstrated a low yield in diagnosing celiac disease. Our aim was to determine the yield of routine SBBx in a large cohort of patients who underwent gastroscopy for the investigation of anemia.MethodsData from consecutive patients who underwent gastroscopy for the investigation of anemia in a tertiary hospital, from January 2008–December 2011, were prospectively collected. Measured outcomes were the prevalence of celiac disease, the yield of duodenal biopsies, and the correlation between celiac serology and diagnosis.ResultsOver 4 years, 987 patients (385 M:602 F; 48.27 ± 15.89 years) underwent endoscopy for anemia, of which 534 (54.1%) had proven iron deficiency anemia (IDA). Abnormal SBBx consistent with celiac disease were found in 2% (22/987), with a higher prevalence in females (3.2%, n = 19 vs 0.8%, n = 3 in males) and in those with IDA (3.6%, n = 19 vs 0.7%, n = 3 in non‐IDA). Macroscopic endoscopic abnormalities were present in 86% (19/22) of patients with celiac disease. Of the 178 patients who had celiac serology, tissue transglutaminase antibody had the highest sensitivity (80%) and specificity (99%). Combined serology had a sensitivity of 85.7%.ConclusionOnly 2% of patients with unexplained anemia had abnormal SBBx consistent with celiac disease and even fewer patients in non‐IDA. Given the availability and high sensitivity of celiac serology and macroscopic changes on endoscopy, SBBx should not be routine during endoscopy but should be limited to those with positive celiac serology, abnormal endoscopic appearance, or females with IDA.

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Narrow-band imaging in the evaluation of villous morphology: a feasibility study assessing a simplified classification and observer agreement

Abstract: Using a simplified classification, we demonstrated the feasibility of using NBI-Z to detect villous atrophy in patients presenting with suspected celiac disease.

Cited by 39 publications

References 13 publications

Narrow band imaging endoscopy for real-time assessment of duodenal villi

Narrow band imaging endoscopy for real-time assessment of duodenal villi

The potential role of optical biopsy in the study and diagnosis of environmental enteric dysfunction

Value of routine duodenal mucosal biopsies in the evaluation of anemia in a large Australian referral centre

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