Introduction Coeliac disease (CD) remains underdiagnosed. Previous studies have shown that up to 13% of patients with CD have undergone a previous gastroscopy where the opportunity to take duodenal biopsies and make a diagnosis had been missed. Clinicians may rely on the presence of endoscopic markers of CD to guide biopsy however these have been shown to lack the required sensitivity. A routine duodenal biopsy approach may solve this problem but this is time consuming and expensive. Methods to improve the macroscopic detection of CD at endoscopy to guide biopsy would seem advantageous. A single trial on I-Scan, a commercially available digital enhancement technique, has shown promising results in identifying markers of villous atrophy. However this was an uncontrolled, unblinded trial in high prevalence population (35% CD). We aimed to assess the utility of I-Scan in a lower prevalence population in a randomised controlled trial.
Methods Patients on a single coeliac enriched endoscopy list were randomised into 2 groups. Group 1 standard HD white light endoscopy (WLE) and group 2 WLE plus I-Scan. The presence of endoscopic markers of CD, scalloping, mosaic pattern, nodularity, loss of duodenal folds or increased vascularity was noted throughout the duodenum. All patients received 4 biopsies from the second part of the duodenum and at least 1 biopsy from the bulb. Coeliac serology was taken at the time of endoscopy. Macroscopic markers of CD are compared to the presence of villous atrophy on histology as the gold standard. 3, 10-point likert scales for pain, discomfort and distress were used to assess tolerability.
Results 116 patients (66 female, mean age 54.9 SD 17.5) have been recruited to date (55 into group 1 and 61 in group 2). In total 14 (12.1%) new diagnoses of CD have been made. I-Scan appears to enhance the appearance of markers for CD and in a single patient in group 2 CD markers that were not noted to be seen on WLE became apparent. Preliminary results show that endoscopic markers of CD across both groups currently have a sensitivity of 78.6% (48.8 – 94.3), specificity 82.4% (73.3 – 88.9), positive and negative predictive values of 37.9% (21.3 – 57.6) and 96.6 (89.5 – 99.1). Median tolerability scores were good in both groups but better in the I-Scan group than WLE alone (4/30 vs. 8/30 p 0.005).
Conclusion The addition of I-Scan to standard endoscopy to aid the diagnosis of CD is well tolerated and is feasible. I-Scan appears to enhance the markings of coeliac disease, however a larger study is required to truly evaluate the effectiveness of I-Scan as an adjunct to standard endoscopy to increase CD diagnosis.
Disclosure of Interest None Declared.