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High accuracy and cost-effectiveness of a biopsy-avoiding endoscopic approach in diagnosing coeliac disease.
Aliment Pharmacol Ther. 2006 Jan 01; 23(1):61-9.AP

Abstract

BACKGROUND

The 'immersion' technique during upper endoscopy allows the visualization of duodenal villi and the detection of total villous atrophy.

AIM

To evaluate the accuracy of the immersion technique in detecting total villous atrophy in suspected coeliac patients. The accuracy in diagnosing coeliac disease and the potential cost-sparing of a biopsy-avoiding approach, based on selection of individuals with coeliac disease-related antibodies and on endoscopic detection of absence of villi, were also analysed.

METHODS

The immersion technique was performed in 79 patients with positive antibodies and in 105 controls. Duodenal villi were evaluated as present or absent. As reference, results were compared with histology. Diagnostic approaches, including endoscopy with or without biopsy, were designed to investigate patients with coeliac disease-related antibodies and total villous atrophy. A cost-minimization analysis was performed.

RESULTS

All patients with positive antibodies had coeliac disease. The sensitivity, specificity, positive and negative predictive values of endoscopy to detect total villous atrophy was always 100%. The sensitivity, specificity, positive and negative predictive values of biopsy-avoiding or biopsy-including strategies in diagnosing coeliac disease when villi were absent was always 100%. The biopsy-avoiding strategy was cost-sparing.

CONCLUSIONS

Upper endoscopy is highly accurate in detecting total villous atrophy coeliac patients. A biopsy-avoiding approach is both accurate and cost-sparing to diagnose coeliac disease in subjects with marked duodenal villous atrophy.

Authors+Show Affiliations

Cammarota G
Department of Internal Medicine and Gastroenterology, Catholic University of Medicine and Surgery, Rome, Italy. gcammarota@rm.unicatt.it
Cesaro P
No affiliation info available
Martino A
No affiliation info available
Zuccalà G
No affiliation info available
Cianci R
No affiliation info available
Nista E
No affiliation info available
Larocca LM
No affiliation info available
Vecchio FM
No affiliation info available
Gasbarrini A
No affiliation info available
Gasbarrini G
No affiliation info available

MeSH

AdolescentAdultAgedAtrophyBiopsyCase-Control StudiesCeliac DiseaseCost-Benefit AnalysisDuodenumEndoscopy, GastrointestinalFemaleHumansIntestinal MucosaMaleMiddle AgedPredictive Value of TestsSensitivity and Specificity

Pub Type(s)

Comparative Study
Evaluation Study
Journal Article

Language

eng

PubMed ID

16393281

Clinical Trial Links

Near-Focus NBI Classification of Villous Atrophy in Suspected Coeliac Disease: International Development and Validation

Citation

Cammarota, G, et al. "High Accuracy and Cost-effectiveness of a Biopsy-avoiding Endoscopic Approach in Diagnosing Coeliac Disease." Alimentary Pharmacology & Therapeutics, vol. 23, no. 1, 2006, pp. 61-9.
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(1):61-9.
Cammarota, G., Cesaro, P., Martino, A., Zuccalà, G., Cianci, R., Nista, E., Larocca, L. M., Vecchio, F. M., Gasbarrini, A., & Gasbarrini, G. (2006). High accuracy and cost-effectiveness of a biopsy-avoiding endoscopic approach in diagnosing coeliac disease. Alimentary Pharmacology & Therapeutics, 23(1), 61-9.
Cammarota G, et al. High Accuracy and Cost-effectiveness of a Biopsy-avoiding Endoscopic Approach in Diagnosing Coeliac Disease. Aliment Pharmacol Ther. 2006 Jan 1;23(1):61-9. PubMed PMID: 16393281.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High accuracy and cost-effectiveness of a biopsy-avoiding endoscopic approach in diagnosing coeliac disease. AU - Cammarota,G, AU - Cesaro,P, AU - Martino,A, AU - Zuccalà,G, AU - Cianci,R, AU - Nista,E, AU - Larocca,L M, AU - Vecchio,F M, AU - Gasbarrini,A, AU - Gasbarrini,G, PY - 2006/1/6/pubmed PY - 2006/5/4/medline PY - 2006/1/6/entrez SP - 61 EP - 9 JF - Alimentary pharmacology & therapeutics JO - Aliment Pharmacol Ther VL - 23 IS - 1 N2 - BACKGROUND: The 'immersion' technique during upper endoscopy allows the visualization of duodenal villi and the detection of total villous atrophy. AIM: To evaluate the accuracy of the immersion technique in detecting total villous atrophy in suspected coeliac patients. The accuracy in diagnosing coeliac disease and the potential cost-sparing of a biopsy-avoiding approach, based on selection of individuals with coeliac disease-related antibodies and on endoscopic detection of absence of villi, were also analysed. METHODS: The immersion technique was performed in 79 patients with positive antibodies and in 105 controls. Duodenal villi were evaluated as present or absent. As reference, results were compared with histology. Diagnostic approaches, including endoscopy with or without biopsy, were designed to investigate patients with coeliac disease-related antibodies and total villous atrophy. A cost-minimization analysis was performed. RESULTS: All patients with positive antibodies had coeliac disease. The sensitivity, specificity, positive and negative predictive values of endoscopy to detect total villous atrophy was always 100%. The sensitivity, specificity, positive and negative predictive values of biopsy-avoiding or biopsy-including strategies in diagnosing coeliac disease when villi were absent was always 100%. The biopsy-avoiding strategy was cost-sparing. CONCLUSIONS: Upper endoscopy is highly accurate in detecting total villous atrophy coeliac patients. A biopsy-avoiding approach is both accurate and cost-sparing to diagnose coeliac disease in subjects with marked duodenal villous atrophy. SN - 0269-2813 UR - https://www.unboundmedicine.com/medline/citation/16393281/High_accuracy_and_cost_effectiveness_of_a_biopsy_avoiding_endoscopic_approach_in_diagnosing_coeliac_disease_ DB - PRIME DP - Unbound Medicine ER -