Confocal Laser Endomicroscopy in the Diagnosis of Celiac Disease

Current application of confocal endomicroscopy in gastrointestinal disorders

“…As observed with histology, the two confocal features (Fig. 6) that were consistently presented in all patients with CD were: (i) villous atrophy (defined as ≤5 blunted‐shaped villi seen a superficial 500 µm × 500 µm CEM view); and (ii) crypt hypertrophy (defined as ≥1 crypts on imaging of the deep mucosa) 60,61 . Based on these criteria, CEM had 70% sensitivity, 95% specificity, and 80% accuracy to establish the diagnosis of CD.…”

“…Based on these criteria, CEM had 70% sensitivity, 95% specificity, and 80% accuracy to establish the diagnosis of CD. The interobserver kappa scores for villous atrophy was 0.67, 1.0 for crypt hypertrophy, and 1.0 for the overall diagnosis of CD 61 …”

“…6) that were consistently presented in all patients with CD were: (i) villous atrophy (defined as Յ5 blunted-shaped villi seen a superficial 500 mm ¥ 500 mm CEM view); and (ii) crypt hypertrophy (defined as Ն1 crypts on imaging of the deep mucosa). 60,61 Based on these criteria, CEM had 70% sensitivity, 95% specificity, and 80% accuracy to establish the diagnosis of CD. The interobserver kappa scores for villous atrophy was 0.67, 1.0 for crypt hypertrophy, and 1.0 for the overall diagnosis of CD.…”

“…The interobserver kappa scores for villous atrophy was 0.67, 1.0 for crypt hypertrophy, and 1.0 for the overall diagnosis of CD. 61 In addition, in order to grade the severity, as well as to assess the mucosal changes of coeliac disease by CEM, a "confocal coeliac score" (CCS) was generated as an objective ratio of images that contained features of CD (either villous atrophy or crypt hypertrophy) against images that did not contain features of CD. 60 This numerical value between 0 and 1 represented a scale of disease severity.…”

Confocal laser endomicroscopy – principles, clinical practice, future trends

“…W zależności od stopnia zaawansowania choroby i głę- bokości skanowania endomikroskopia ukazuje redukcję długości lub zupełny brak kosmków, z uwidocznieniem ujścia krypt gruczołowych (okrągłe struktury z radiacyjnym układem enterocytów otaczającech ujście), a w niektórych przypadkach jest możliwa identyfikacja zwięk-szonej limfocytozy śródnabłonkowej [21]. W prospektywnym badaniu [22] obejmującym 31 osób (11 z rozpoznaną chorobą trzewną leczonych dietą bezglutenową, 6 nieleczonych, 14 w grupie kontrolnej) oceniano przydatność metody w rozpoznawaniu celiakii, ocenie stopnia zaawansowania choroby i odpowiedzi na leczenie w porównaniu z klasyczną histopatologią bipotatów kleszczykowych.…”