Pilot study on the correlation of optical coherence tomography with histology in celiac disease and normal subjects

Background and Aim: Celiac disease (CD) is a common condition but often it goes unrecognized because characteristic histopathological abnormalities must be found to confirm the diagnosis. A way is needed to select patients who need biopsy of the duodenal mucosa to detect CD. No data are currently available on the use of in vivo optical coherence tomography (OCT), during real-time endoscopic imaging, in the small intestine and, particularly, in the diagnosis of CD. The aim of the present study was to test the utility of OCT in patients undergoing esophagogastroduodenoscopy (EGD) for histological diagnosis.

Methods: Eighteen patients with suspected CD (positive for antigliadin, antiendomysial and antitransglutaminase antibodies) and 22 dyspeptic subjects (negative for these antibodies) who were also examined by EGD, were prospectively enrolled. OCT scans of descending duodenum were taken during diagnostic EGD, with biopsies of the same duodenal area. OCT images and histological specimens were evaluated blindly, analysis being done independently by a gastroenterologist and a pathologist. Three patterns of intestinal villous morphology were considered (1, no atrophy; 2, mild atrophy; 3, marked atrophy).

Results: Concordance was total between OCT and histology for villi morphology in both patients and normal subjects.

Conclusions: OCT appears to be a promising method for correctly identifying villous atrophy; it may help in selecting patients for intestinal biopsies, considering the limited usefulness of endoscopic criteria, and may also help the endoscopist to perform target biopsies in mucosal areas where the villi are damaged or absent, considering that CD often causes patchy mucosal lesions.