M Le Rhun

In vivo real-time imaging of human duodenal mucosal structures in celiac disease using endocytoscopy

BACKGROUND AND AIMS Celiac disease is a gluten-induced enteropathy whose diagnosis is based on histological evidence of villous atrophy. The diagnosis may be difficult if the orientation of histological sections is other than optimal. During upper gastrointestinal endoscopy we studied in vivo duodenal mucosa in patients with celiac disease using endocytoscopy, a novel diagnostic technique allowing in vivo real-time visualization of mucosa under x 450 magnification. METHODS Sixteen patients with documented celiac disease and seven controls without celiac disease were studied. Endocytoscopic images obtained from several fields were compared in a blinded fashion to standard histology. RESULTS Endocytoscopy showed three different patterns of in vivo histology: (1) the presence of normal-appearing, long, thin villi, lined with clearly distinguishable surface epithelial cells, considered to be normal duodenal mucosa (n = 15, all controls and eight celiac disease patients); (2) the presence of thick, shortened villi, reflecting partial villous atrophy (n = 4); and (3) the total absence of villi and the presence of enlarged crypt orifices, reflecting total villous atrophy (n = 4). Good concordance between endocytoscopy and standard histology was found in all 16 patients with celiac disease. CONCLUSIONS Endocytoscopy allows in vivo, real-time, noninvasive visualization and characterization of villous architecture and may be a promising method for in vivo evaluation of duodenal mucosa in celiac disease.

Nouvelles perspectives en endoscopie diagnostique: la vidéocapsule

Since the beginning of the millennium, the development of wireless capsule endoscopy has represented a major technological advance. The capsule is ingested by the patient and images are transmitted via several sensors positioned on the skin of the patient and downloaded in a computer system. The first applications were focused on the exploration of the small bowel which was previously considered as an obscure area for conventional endoscopy. Wireless capsule endoscopy of the small bowel is now an established technique with many acknowledged indications for the diagnosis of obscure bleeding, anemia of presumed digestive origin, Crohns disease and small bowel tumors. Recently, thanks to technological progresses, novel capsules have been developed for specific segments of the gut namely the oesophagus and the colon. Recent data suggest that these new capsules could have potential applications for the diagnosis of oesophageal varices, Barretts oesophagus and for the screening and/or surveillance of polyps of the colon. However, further studies are required before such strategies could be approved for clinical use or even replace conventional endoscopic modalities. In the long-term, progresses in signal processing as well as in the miniaturisation of sensors or markers may lead to a new generation of endoscopic robots. This technological breakthrough may ultimately result in new concepts and change current practice of digestive endoscopy.