Towards improved celiac disease diagnosis

Celiac disease (CD) has a prevalence of 1%. To confirm the diagnosis, children with serologically suspected CD undergo small bowel biopsy. To avoid biopsies but still reliably prove the diagnosis, a variety of new endoscopic techniques including software for the analysis of endoscopic still images has been developed. If automated analysis-software can detect villous atrophy not only in endoscopic still images but in video clips as well, in such cases, a small bowel biopsy could entirely be avoided. The main question we will try to assess is, if such software can be developed and easily integrated into the routine of pediatric endoscopy. Furthermore, we will examine if the narrow band imaging technique, an optical/digital chromoendoscopy, can further improve the reliability of automated analysis. Various feature extraction and classification strategies will be applied for automated differentiation between presence and absence of villous atrophy in the endoscopic video clips. 1

In pediatric celiac disease, having a prevalence of 1%, a biopsy of the small bowel is recommended in the case of unclear serology to clarify diagnosis. The reliability of the corresponding histology findings is problematic due to two reasons: (1) Celiac disease exhibits a so-called patchy distribution in some cases, which means that not the entire mucosa is affected. Misdiagnosis may happen in case the celiac disease affected mucosa areas are missed and biopsies have been taken from healthy areas. (2) Pathological diagnosis of biopsy specimens suffers from high inter- and intra-observer variability. Thus, there is need for observer-independent diagnostic methods for celiac disease. In this project the computer-based analysis of endoscopy still images allowed to reliably detect villous atrophy and as such confirm the diagnosis of celiac disease. Furthermore, an computer-based analysis was also successfully developed for and used on endoscopic video, thus enhancing the accuracy of biopsy targeting on the one hand, on the other hand abandoning the necessity of conducting small bowel biopsy at all when villous atrophy was detected. This new diagnostic approach increases the patients` safety during endoscopy, but also significantly contributes to cost reduction as the entire biopsy diagnostic work-up can be avoided.