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Background: New generation videoendoscopes potentially may visualize duodenal villi. This study compared endoscopic findings with this type of instrument to the histopathologic evaluation of duodenal villi., Methods: A total of 191 patients underwent upper endoscopy for the purpose of obtaining duodenal biopsy specimens. The findings were assessed independently by 3 experienced observers by using a commercially available, high-resolution, high-magnifying (x2) videoendoscope. The duodenal villous profile was determined by endoscopic magnification and by endoscopic magnification after filling the duodenum with water. With both endoscopic magnification and endoscopic magnification after filling the duodenum with water, villous patterns were scored as the following: definitely present, partially present, or definitely absent. Villous patterns also were histopathologically scored as the following: normal, partial villous pattern, or total villous atrophy., Results: Interobserver variability was excellent (kappa = 0.93). The concordance between either endoscopic magnification or endoscopic magnification after filling the duodenum with water and histology was 100% for presence/absence of villi. The sensitivity, the specificity, and the positive and negative predictive values of endoscopic magnification for detection of any villous abnormality were 95%, 99%, 95%, and 99%, respectively; the respective values of endoscopic magnification after filling the duodenum with water were 95%, 98%, 92%, and 99%., Conclusions: High-resolution magnifying upper endoscopy can reliably predict the presence or the absence of duodenal villi.

Background: Upper endoscopy is not routinely performed to directly detect abnormalities of the duodenal villi. The reliability of the immersion technique for assessment of duodenal villi was evaluated in a series of patients with dyspepsia., Methods: A total of 396 patients who were to undergo standard EGD for dyspeptic symptoms were enrolled. Patients with suspected malabsorption were excluded. By performing a "modified immersion technique," duodenal villi were scored as the following: definitely present, partially present, or definitely absent. Three duodenal biopsy specimens were obtained from each patient, and villi also were scored histologically as the following: normal, partial villous pattern, or total villous atrophy., Results: Sensitivity, specificity, and positive and negative predictive values of the modified immersion technique for detection of total villous atrophy were 100%, 99.7%, 85.7%, and 100%, respectively. Sensitivity, specificity, and positive and negative predictive values of modified immersion technique for detection of partial villous patterns were 75%, 99.5%, 60%, and 99.7%, respectively. Sensitivity, specificity, and positive and negative predictive values for modified immersion technique detection of any villous abnormality (partial or total villous atrophy) were 90.9%, 99.5%, 83.3%, and 99.7%, respectively., Conclusions: During standard EGD, duodenal evaluation by modified immersion technique can reliably detect abnormalities of duodenal villi. This simple diagnostic technique may be performed routinely during endoscopic exploration of duodenum.