Indian Journal of Gastroenterology

, Volume 33, Issue 5, pp 440–444 | Cite as

Use of narrow band imaging in assessing duodenal villous atrophy

  • Amitava GoswamiEmail author
  • Sunil Dadhich
  • Narendra Bhargava
Original Article


Background and Objective

Narrow band imaging endoscopy with magnification (NBI-ME) has already been established in Barrett’s esophagus, stomach, and colonic mucosa, but limited work has been done in the mucosal evaluation of duodenum. A study was done to determine the correlation between NBI and histology in grading villous architecture in varied etiology.


A prospective observational study comprising 105 subjects with suspected malabsorption. The presence of a diagnosed celiac disease, severe life threatening comorbidity, or pregnancy was considered as exclusion criteria. Standard endoscopy (SE), NBI-ME, multiple duodenal biopsies with histopathological examination were done in all.


Fifty-one patients had celiac disease while 54 patients comprised mainly functional dyspepsia, iron deficiency anemia, tropical malabsorption syndrome, and irritable bowel syndrome. Four NBI-ME image subtypes of villous morphology have been proposed (NBI type I/II/III/IV). NBI-ME had 95 % sensitivity, 90.2 % specificity, 91.2 % positive predictive value, and 94.2 % negative predictive value for diagnosing altered villous morphology. Intraobserver kappa agreement coefficient (κ) for NBI-ME was 0.83 while interobserver agreement was 0.89 (95 % CI 0.8–0.97).


NBI-ME has good performance characteristics and very good kappa intra/interobserver agreement coefficient for varied subtypes of villous morphology. NBI-ME is most useful for obtaining a targeted biopsy which can be missed by conventional white light endoscopy.


Celiac disease Narrow band imaging image subtypes Narrow band imaging with magnifying endoscopy Negative predictive value Positive predictive value Sensitivity Specificity Standard endoscopy 


Conflict of interest

AG, SD, and NB all declare that they have no conflict of interest.

Ethical statement

The study was performed in a manner to conform to the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning Human and Animal Rights, and the authors followed the policy concerning Informed Consent as shown on


  1. 1.
    Bottaro G, Cataldo F, Rotolo N, et al. The clinical pattern of subclinical/- silent celiac disease: an analysis on 1026 consecutive cases. Am J Gastroenterol. 1999;94:691–6.PubMedGoogle Scholar
  2. 2.
    West J, Logan RF, Hill PG, et al. Seroprevalence, correlates and characteristics of undetected coeliac disease in England. Gut. 2003;52:960–5.PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Bardella MT, Minoli G, Radaelli F, et al. Reevaluation of duodenal endoscopic markers in the diagnosis of celiac disease. Gastrointest Endosc. 2000;51:714–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Maurino E, Capizzano H, Niveloni S, et al. Value of endoscopic markers in celiac disease. Dig Dis Sci. 1993;38:2028–33.PubMedCrossRefGoogle Scholar
  5. 5.
    Tursi A, Brandimarte G, Giorgetti GM, et al. Endoscopic features of celiac disease in adults and their correlation with age, histological damage, and clinical form of the disease. Endoscopy. 2002;34:787–92.PubMedCrossRefGoogle Scholar
  6. 6.
    Achkar E, Carey WD, Petras R, et al. Comparison of suction capsule and endoscopic biopsy of small bowel mucosa. Gastrointest Endosc. 1986;32:278–81.PubMedCrossRefGoogle Scholar
  7. 7.
    Dickey W, Hughes D. Prevalence of celiac disease and its endoscopic markers among patients having routine upper gastrointestinal endoscopy. Am J Gastroenterol. 1999;94:2182–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Singh R, Nind G, Tucker G, et al. Narrow-band imaging in the evaluation of villous morphology: a feasibility study assessing a simplified classification and observer agreement. Endoscopy. 2010;42:889–94.PubMedCrossRefGoogle Scholar
  9. 9.
    Husby S, Koletzko S, Korponay-Szabo IR, et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr. 2012;54:136–60.PubMedCrossRefGoogle Scholar
  10. 10.
    Oberhuber G, Granditsch G, Vogelsang H. The histopathology of coeliac disease: time for a standardized report scheme for pathologists. Eur J Gastroenterol Hepatol. 1999;11:1185–94.PubMedCrossRefGoogle Scholar
  11. 11.
    Sharma P, Bansal A, Mathur S, et al. The utility of a novel narrow band imaging endoscopy system in patients with Barrett’s esophagus. Gastrointest Endosc. 2006;64:167–75.PubMedCrossRefGoogle Scholar
  12. 12.
    Kara MA, Ennahachi M, Fockens P, et al. Detection and classification of the mucosal and vascular patterns (mucosal morphology) in Barrett’s esophagus by using narrow band imaging. Gastrointest Endosc. 2006;64:155–66.PubMedCrossRefGoogle Scholar
  13. 13.
    Singh R, Anagnostopoulos GK, Yao K, et al. Narrow-band imaging with magnification in Barrett’s esophagus: validation of a simplified grading system of mucosal morphology patterns against histology. Endoscopy. 2008;40:457–63.PubMedCrossRefGoogle Scholar
  14. 14.
    Yao K, Takaki Y, Matsui T, et al. Clinical application of narrow band imaging in the upper gastrointestinal tract: new imaging techniques for detecting and characterising gastrointestinal neoplasia. Gastrointest Endosc Clin N Am. 2008;18:415–33.PubMedCrossRefGoogle Scholar
  15. 15.
    East J, Suzuki N, Saunders BP. Comparison of magnified pit pattern interpretation with narrow band imaging versus chromoendoscopy for diminutive colonic polyps: a pilot study. Gastrointest Endosc. 2007;66:310–6.PubMedCrossRefGoogle Scholar
  16. 16.
    De Luca L, Ricciardiello L, Rocchi MB, et al. Narrow band imaging with magnification endoscopy for celiac disease: results from a prospective, single-center study. Diagn Ther Endosc. 2013;2013:580526.Google Scholar
  17. 17.
    Ranjan P, Ghosal UC, Aggarwal R, et al. Etiological spectrum of sporadic malabsorption syndrome in northern Indian adults at a tertiary hospital. Indian J Gastroenterol. 2004;23:94–8.PubMedGoogle Scholar
  18. 18.
    Yadav P, Das P, Mirdha BR, et al. Current spectrum of malabsorption syndrome in adults in India. Indian J Gastroenterol. 2011;30:22–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Ghoshal UC, Mehrotra M, Kumar S, et al. Spectrum of malabsorption syndrome among adults and factors differentiating celiac disease and tropical malabsorption. Indian J Med Res. 2012;136:451–9.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Cammarota G, Cesaro P, Cazzato A, et al. Optimal band imaging system: a new tool for enhancing the duodenal villous pattern in celiac disease. Gastrointest Endosc. 2008;68:352–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Banerjee R, Reddy DN. High-resolution narrow band imaging can identify patchy atrophy in celiac disease: targeted biopsy can increase diagnostic yield. Gastrointest Endosc. 2009;69:984–5.PubMedCrossRefGoogle Scholar

Copyright information

© Indian Society of Gastroenterology 2014

Authors and Affiliations

  • Amitava Goswami
    • 1
    Email author
  • Sunil Dadhich
    • 1
  • Narendra Bhargava
    • 1
  1. 1.Department of GastroenterologyDr. Sampurnanand Medical CollegeJodhpurIndia

Personalised recommendations