Background and Aims: Confocal laser endomicroscopy (CLE) is a recent
development that enables surface and subsurface imaging of living cells in
vivo at 1000 magnification. The aims of the present study were to define
confocal features of celiac disease (CD) and to evaluate the usefulness of the
CLE in the diagnosis of CD in children in comparison to histology.
Patients and Methods: Nine patients (8 girls)with a median age of 8.35 years
(range 2–12.66 years) and a median weight of 28.3 kg (range 11–71 kg) were
suspected with CD and 10 matched controls underwent oesophagogastroduodenoscopy
using the confocal laser endomicroscope (EC3870CILK;
Pentax, Tokyo, Japan). Histologic sections were compared with the
confocal images of the same site by 2 experienced paediatric
histopathologists and endoscopists, all ofwhom were blinded to the diagnosis.
Results: The median procedure time was 17 minutes (range 8–25 minutes).
Confocal features of CD were defined and a score was developed. A total of
1384 confocal images were collected from 9 patients and 10 controls. Five
images from each patient and control were selected and compared with the
biopsy specimen of the same site. The sensitivity, specificity, and positive
predictive value for the confocal images in comparison to the histology were
100%, 80%, and 81%. The kappa inter-observer agreement between the 2
endoscopists was 0.769 (P¼0.018) and between the 2 histopathologists was
0.571 (P¼0.05).
Conclusions: Confocal endomicroscopy offers the prospect of diagnosis of
CD during ongoing endoscopy. It also enables targeting biopsies to abnormal
mucosa and thereby increasing the diagnostic yield, especially when villous
atrophy is patchy in the duodenum.
Key Words: celiac disease, endomicroscopy, gastrointestinal, histology,
paediatric