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Probe-Based Confocal Laser Microscopy Identifies Criteria Predictive of Active Celiac Sprue

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Abstract

Background

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.

Aims

To develop CLM criteria most predictive of celiac pathology in a prospective pilot study.

Methods

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.

Results

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).

Conclusions

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.

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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.

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Authors and Affiliations

  1. Department of Gastroenterology, VA Medical Center, White River Junction, VT, USA

    Heiko Pohl

  2. Department of Medicine, Division of Gastroenterology and Hepatology, Charité Medical Center - Virchow Hospital, Medical School of the Humboldt-University of Berlin, 13344, Berlin, Germany

    Barbara T. Tanczos, Ahmed C. Khalifa & Daniel C. Baumgart

  3. Department of Pathology, Charité Medical School, Humboldt-University of Berlin, Berlin, Germany

    Birgit Rudolph

  4. IInd Medical Department, Technical University of Munich, Munich, Germany

    Alexander Meining

  5. Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany

    Thomas Rösch

Authors
  1. Heiko Pohl
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  2. Barbara T. Tanczos
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  3. Birgit Rudolph
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  4. Alexander Meining
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  5. Ahmed C. Khalifa
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  6. Thomas Rösch
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  7. Daniel C. Baumgart
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Corresponding author

Correspondence to Daniel C. Baumgart.

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Pohl, H., Tanczos, B.T., Rudolph, B. et al. Probe-Based Confocal Laser Microscopy Identifies Criteria Predictive of Active Celiac Sprue. Dig Dis Sci 57, 451–457 (2012). https://doi.org/10.1007/s10620-011-1866-9

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  • DOI: https://doi.org/10.1007/s10620-011-1866-9

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