NEW METHODS: Clinical Endoscopy Optimal band imaging system: a new tool for enhancing the duodenal villous pattern in celiac disease Giovanni Cammarota, MD, Paola Cesaro, MD, Alessia Cazzato, MD, Paolo Fedeli, MD, Lucia Sparano, MD, Fabio M. Vecchio, MD, Luigi M. Larocca, MD, Giovanni Gasbarrini, MD Rome, Italy Background: The optimal band imaging (OBI) system is a new technology that can select better spectral images decomposed from ordinary endoscopic images. This technology, first introduced as ‘‘FUJI Intelligent Color Enhancement,’’ enhances the contrast of the mucosal surface without the use of dyes. Objective: This study aimed to evaluate the potential of OBI for predicting the duodenal villous morphologic characteristics in patients with suspected celiac disease. Design: This study was designed as an open, prospective, single-center trial. Duodenoscopy was performed with a high-resolution magnification view, in association with OBI spectral processing. Duodenal villous patterns were evaluated and classified as normal, partially atrophic, or markedly atrophic. The endoscopic results were then compared with the histologic diagnosis. Setting: Endoscopy unit at the A. Gemelli University Hospital of Rome, Italy. Patients: Sixty-one patients undergoing upper endoscopy for clinical history of malabsorption or serologic suspicion for celiac disease were included in the study. Results: From OBI sets using red, green, and blue wavelength combinations that ranged from 400 to 580 nm, the endoscopist was able to find marked villous atrophy of the duodenum in 16 subjects, partial villous atrophy in 9 subjects, and normal villi in the remaining 36 subjects. The sensitivity, specificity, and positive and negative predictive values of the OBI-based duodenoscopy were 100% accurate in the evaluation of villous patterns. Conclusions: High-resolution magnification endoscopy with OBI allows clear visualization of the duodenal villous pattern. The OBI system may play a potential role in optimizing the diagnostic accuracy of endoscopy in celiac disease. Standard endoscopy does not usually allow the visuali- zation of duodenal villous patterns and may be inaccurate in patients with celiac disease. 1-6 In the current study, we investigated the ability of a high-resolution magnifying videoendoscope equipped with the optimal band imaging (OBI) system to evaluate the duodenal villous morpho- logic characteristics during upper GI endoscopy. 7 This technology, which is commercially available, was initially introduced by Fujinon Corporation as ‘‘FUJI Intelligent Color Enhancement.’’ 7 This system is based on the selec- tion of a spectral transmittance with a dedicated wave- length and has the potential to lead to the same contrast enhancement capabilities as traditional chro- moendoscopy but without the use of staining agents. 8 Re- cently, the OBI system has been successfully used to identify neoplasic areas within Barrett’s esophagus and to recognize depressed-type early gastric cancer. 9,10 MATERIAL AND METHODS Study design and patients Sixty-one consecutive patients (41 female and 20 male, mean age 43 years, range 15-78 years) with clinical history of malabsorption or serologic suspicion for celiac disease were enrolled in the current study. Although the presence of severe GI or systemic diseases (eg, liver cirrhosis, blood coagulation disorders) was considered as an exclusion Abbreviations: MVA, marked villous atrophy; OBI, optimal band imag- ing; PVA, partial villous atrophy; RGB, red, green, blue. Copyright ª 2008 by the American Society for Gastrointestinal Endoscopy 0016-5107/$32.00 doi:10.1016/j.gie.2008.02.054 352 GASTROINTESTINAL ENDOSCOPY Volume 68, No. 2 : 2008 www.giejournal.org