Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Feb 16, 2019; 11(2): 145-154
Published online Feb 16, 2019. doi: 10.4253/wjge.v11.i2.145
Narrow band imaging evaluation of duodenal villi in patients with and without celiac disease: A prospective study
James H Tabibian, Jean F Perrault, Joseph A Murray, Konstantinos A Papadakis, Felicity T Enders, Christopher J Gostout
James H Tabibian, Jean F Perrault, Joseph A Murray, Konstantinos A Papadakis, Christopher J Gostout, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
James H Tabibian, Division of Gastroenterology, Olive View-UCLA Medical Center, Sylmar, CA 91342, United States
Felicity T Enders, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN 55905, United States
Author contributions: Tabibian JH, Perrault JF, Enders FT, and Gostout CJ designed the study; Tabibian JH, Perrault JF, Murray JA, and Papadakis KA acquired images; Tabibian JH, Perrault JF, Murray JA, Papadakis KA and Gostout CJ reviewed images; Tabibian JH drafted the manuscript; Enders FT provided statistical support; Perrault JF and Gostout CJ provided supervision; all authors provided critical input on and approved of the manuscript.
Supported by the National Institutes of Health, No. T32DK007198 in part during the study period.
Institutional review board statement: Exempt status was obtained from the Mayo Clinic IRB.
Conflict-of-interest statement: No conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: James H Tabibian, MD, PhD, Associate Professor of Medicine, Director of Endoscopy, Division of Gastroenterology, Olive View-UCLA Medical Center, 14445 Olive View Dr., 2B-182, Sylmar, CA 91342, United States. jtabibian@dhs.lacounty.gov
Telephone: +1-747-2103205 Fax: +1-747-2104573
Received: November 5, 2018
Peer-review started: November 5, 2018
First decision: November 28, 2018
Revised: January 9, 2019
Accepted: January 26, 2019
Article in press: January 26, 2019
Published online: February 16, 2019
Research background

Duodenal mucosal biopsies are routinely obtained during upper endoscopy (EGD) but very often are histopathologically normal.

Research motivation

To decrease unnecessary biopsies, a more strategic method for examining the duodenal mucosa is needed.

Research objectives

The primary aim of this study was to examine the clinical utility of narrow band imaging (NBI) for evaluating the morphology.

Research methods

We performed a prospective cohort study of patients at Mayo Clinic Rochester who were referred for EGD with a request for duodenal biopsies. The performing staff endoscopist scored, in real-time during EGD, the NBI-based appearance of duodenal villi into one of three categories (normal, partial villous atrophy, or complete villous atrophy), captured ≥ 2 representative duodenal NBI images, and obtained duodenal mucosal biopsies. NBI images were then scored by an advanced endoscopist and fellow, and biopsies (gold standard) by a pathologist, in a masked fashion using the same three-category classification. Performing endoscopist, advanced endoscopist, and fellow NBI scores were compared to histopathology scores to calculate performance characteristics [sensitivity, specificity, positive and negative (NPV) predictive values, and accuracy]. Inter-rater agreement was assessed with Cohen’s kappa.

Research results

A total of 112 patients were included in the study. The most common referring indications for EGD with duodenal biopsies were dyspepsia (47%), nausea (23%), and suspected celiac disease (14%). Histopathology scores of duodenal biopsies were: 84% normal, 11% partial atrophy, and 5% complete atrophy. Performing endoscopist duodenal NBI scores were 79% normal, 14% partial atrophy, and 6% complete atrophy compared to 91%, 5%, and 4% and 70%, 24%, and 6% for advanced endoscopist and GI fellow, respectively. Diagnostic performance was favorable for all three raters compared to histopathology, and NPV was particularly high (92-100%). NBI score agreement was best between performing endoscopist and fellow (κ = 0.65).

Research conclusions

NBI inspection during EGD facilitates accurate, non-invasive evaluation of duodenal villi. It’s particularly high NPV may render it most useful for foregoing biopsies of duodenal mucosa likely to be histopathologically normal.

Research perspectives

We believe NBI should routinely be applied to the duodenum during EGD prior to obtaining duodenal biopsies in order to help determine their likely histopathological yield and better target (rather than randomly approach) their acquisition.