Optical coherence tomography in pediatric patients: A feasible technique for diagnosing celiac disease in children with villous atrophy

Background and aim: Celiac disease is a common condition with many atypical manifestations, where histology serves as the gold standard for diagnosis. A useful new technique, optical coherence tomography, can depict villous morphology in detail, using light waves. This Study examined the correlation between the sensitivity and specificity of optical coherence tomography in pediatric patients undergoing esophago-gastro-duodenoscopy for the diagnosis of celiac disease. Materials and methods: A total of 134 children were prospectively enrolled, 67 with a serological suspicion of celiac disease (group I) and 67 with negative histology for celiac disease (group 2). During a diagnostic esophago-gastro-duodenoscopy we acquired multiple images and films in the four quadrants of the second part of the duodenum, and biopsies were taken in the area where optical coherence tomography had been done. Three patterns of villous morphology were considered: pattern 1 = no atrophy (types 0, 1 or 2 of the Marsh classification); pattern 2 = mild atrophy (type 3a or 3b); pattern 3 = marked atrophy (type 3c). Results: The diagnosis of celiac disease was histologically confirmed in all 67 children with positive antiendomysium and/or antitransglutaminase antibodies. Optical coherence tomography correlated with pattern I histology in 11/11 cases, pattern 2 in 30/32 (93.8%) and pattern 3 in 22/24 (91.6%). Sensitivity and specificity were 82% and 100%. In the control group there was 100% concordance between optical coherence tomography and histology. The overall concordance between optical coherence tomography and histology in determining patchy lesions was 75%. Conclusion: Optical coherence tomography could be a helpful diagnostic tool in children with mild or marked villous atrophy for diagnosing celiac disease during upper gastrointestinal (GI) endoscopy, avoiding biopsies. However, duodenal biopsies are mandatory if the optical coherence tomography shows normal villous morphology in patients with positive antibodies. (C) 2009 Published by Elsevier Ltd on behalf of Editrice Gastroenterologica Italiana S.r.l.