High definition endoscopy with or without I-Scan increases the detection of celiac disease during routine endoscopy

Background and aims: Celiac disease remains underdiagnosed at endoscopy. We aimed to assess the utility of I-Scan (virtual chromo-endoscopy) to improve sensitivity of endoscopy to detect markers of villous atrophy in this condition. Methods: Patients from 2 UK hospitals were studied in 3 groups. Group 1: standard high definition, white light endoscopy (WLE); Group 2: WLE plus I-Scan; Group 3: non-high definition control group. The presence of endoscopic markers was recorded. At least 4 duodenal biopsies were taken from all patients. Serology was performed concurrently and observations were compared with histology. Results: 758 patients (62% female, mean age 52) were recruited (Group 1: 230; Group 2: 228; Group 3: 300). 135 (17.8%) new diagnoses of coeliac disease were made (21 Group 1; 24 Group 2; 89 Group 3). The sensitivity for detection of endoscopic markers of villous atrophy was significantly higher in both Group 1 (85.7%, p = 0.0004) and Group 2 (75%, p = 0.005) compared to non-high definition controls (41.6%). There was no significant difference between high definition only and I-Scan groups (p = 0.47). In non-high definition endoscopy a missed diagnosis was associated with lesser degrees of villous atrophy (p = 0.019) and low tTG titre (p = 0.007). Conclusions: High definition endoscopy with or without I-Scan increases the detection of celiac disease during routine endoscopy. (C) 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.