To:
ADC Fetal and Neonatal Edition Letters and ADC Education and Practice Letters
Electronic Letters to:
|
|
Electronic letters published:
-
![[Read eLetter]](/icons/misc/sectionDOWN.gif)
Emerging technology in endoscopy for the diagnosis of celiac disease in children. A look around.
- Gianluca Ianiro, Alessia Cazzato, Giovanni Gasbarrini, Giovanni Cammarota (6 March 2008)
|
|
|||
|
Gianluca Ianiro, medical doctor Endoscopy Unit, Department of Internal Medicine; Catholic University, Rome, Italy, Alessia Cazzato, Giovanni Gasbarrini, Giovanni Cammarota
Send letter to journal:
jnl_original{at}hotmail.com Gianluca Ianiro, et al.
|
Dear Editor, we have read with interest and attention the Sidhu and colleagues’ review on the modern modalities to investigate the small bowel in paediatrics (1). The review prompts us for some additional considerations, particularly about the modern modalities available to diagnose celiac disease during upper intestinal endoscopy. Nowadays, the modern upper video-endoscopy offers the chance of predicting diagnosis of celiac disease with the contribution of new and effective technology for the exploration of the proximal small bowel. For example, the so-called “water-immersion technique” is an easy and novel procedure, that allows the visualization of the duodenal villous pattern directly during the upper gastrointestinal endoscopy. It consists in the introduction of water into the duodenum, after removing air from the lumen, and allows to reach very accurate results (2-4). In addition, new generation videoendoscopes with high-resolution and magnification imaging properties, may potentially visualize duodenal villous pattern as well. Some recent studies have already demonstrated the value of this technology in increasing the endoscopic diagnostic accuracy (5-6). Finally, a modern modality to perform video-endoscopy, based on the “optimal band imaging” system (7), is able to provide a computed virtual chromoendoscopy which may potentially be useful for optimizing the endoscopic prediction of diagnosis in celiac disease. Probably in the future, by a throught use of all these technologies, we’ll have the chance of a careful inspection of the duodenal mucosa, keeping in mind the objective of a cost-saving (8, 9) and especially patient-keeping approach for this worldwide disease. References 1. Sidhu R, Sanders DS, McAlindon ME, et al. Capsule endoscopy and enteroscopy : modern modalities to investigate the small bowel in paediatrics. Arch Dis Child 2008;93;154-159. 2. Cammarota G, Pirozzi GA, Martino A, et al. A. Reliability of the "immersion technique" during routine upper endoscopy for detection of abnormalities of duodenal villi in patients with dyspepsia. Gastrointest Endosc 2004;60:223-228. 3. Cammarota G, Cesaro P, La Mura R, et al. Role of the "immersion technique" in diagnosing celiac disease with villous atrophy limited to the duodenal bulb. J Clin Gastroenterol 2007;41:571-575. 4. Cammarota G, Cuoco L, Cesaro P, et al. A highly accurate method for monitoring histological recovery in patients with celiac disease on a gluten-free diet using an endoscopic approach that avoids the need for biopsy: a double-center study. Endoscopy 2007;39:46-51. 5. Cammarota G, Martino A, Pirozzi GA, et al. Direct visualization of intestinal villi by high-resolution magnifying upper endoscopy: a validation study. Gastrointest Endosc 2004;60:732-738. 6. Badreldin R, Barrett P, Wooff DA, et al. How good is zoom endoscopy for assessment of villous atrophy in coeliac disease? Endoscopy 2005;37:994- 998. 7. 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 (in press) 8. Cammarota G, Cesaro P, Martino A, et al. High accuracy and cost- effectiveness of a biopsy-avoiding endoscopic approach in diagnosing coeliac disease. Aliment Pharmacol Ther 2006;23:61-69. 9. Cammarota G, Gasbarrini A, Gasbarrini G. No more biopsy in the diagnostic work-up of celiac disease. Gastrointest Endosc 2005;62:119-121. |
|||
