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Diagnostic values of duodenal endoscopic markers in paediatric coeliac patients
Amal Sahyouni1, Ali Ibrahim2, Alexander Ibrahim1
1Tishreen University, Latakia, Syria.
Insights
Endoscopic markers in the duodenum, like scalloping, aid in identifying children with coeliac disease (CD). Careful duodenal examination during endoscopy is crucial for accurate CD diagnosis.
Area of Science:
- Gastroenterology
- Pediatric Endoscopy
- Celiac Disease Diagnosis
Background:
- Endoscopic markers in the duodenum can indicate a higher likelihood of developing coeliac disease (CD).
- Accurate identification of these markers is essential for timely diagnosis and management.
Purpose of the Study:
- To evaluate the diagnostic accuracy of specific duodenal endoscopic markers for coeliac disease in children.
- To determine the sensitivity, specificity, and predictive values of observed endoscopic findings.
Main Methods:
- Retrospective analysis of 504 children (0-15 years) undergoing esophagogastroduodenoscopy (EGD) for suspected CD.
- Evaluation of four duodenal endoscopic markers: scalloping, reduced folds, nodular pattern, and white spots.
Main Results:
- 123 out of 504 children were diagnosed with CD (24.4%).
- At least one marker was present in 39.6% of patients, with high overall diagnostic values (Sensitivity 91%, Specificity 76%).
- Scalloping demonstrated the highest sensitivity (89%) and specificity (96%).
Conclusions:
- Duodenal endoscopic examination is valuable for identifying children with coeliac disease.
- Scalloping is the most prevalent endoscopic marker.
- High negative predictive values warrant cautious interpretation, as CD diagnosis can be missed.
Background And Study Aims:
The recognition of suggestive endoscopic markers in the duodenum during open access endoscopy can help identifying patients who are likely to develop coeliac disease (CD). This study aims to determine the diagnostic accuracy of duodenal endoscopic markers for the diagnosis of CD.
Patients And Methods:
All children (0-15 years) who underwent oesophagogastroduodenoscopy (EGD) for any reason suggestive of CD at the paediatric department of Al-Assad University Hospital in Latakia, Syria during a 4-year period (from January 2010 to December 2013) were retrospectively included, in the study; this yielded a consecutive cohort without selection bias. The relevant data were obtained from the patients' files. Four duodenal endoscopic markers, including scalloping, reduction of duodenal folds, nodular mucosal pattern, and scattered white spots, were evaluated.
Results:
During the study period, 504 children underwent EGD of whom 123 (24.4%) were ultimately diagnosed with CD. At least one marker was observed in 200/504 children (39.6%) and the diagnostic values were as follows: Sensitivity (91%), specificity (76%), positive predictive value (56%), and negative predictive value (97%). Scalloping had the highest sensitivity and specificity of 89% and 96%, respectively.
Conclusion:
Careful examination of the second and third parts of the duodenum during endoscopy can be helpful in identifying CD. Scalloping is the most common endoscopic marker, and the high NPV values of endoscopic markers should be interpreted cautiously, as the diagnosis of CD can be missed.
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