Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Oct 16, 2016; 8(18): 653-662
Published online Oct 16, 2016. doi: 10.4253/wjge.v8.i18.653
Recommendations to quantify villous atrophy in video capsule endoscopy images of celiac disease patients
Edward J Ciaccio, Govind Bhagat, Suzanne K Lewis, Peter H Green
Edward J Ciaccio, Govind Bhagat, Suzanne K Lewis, Peter H Green, Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York, NY 10032, United States
Govind Bhagat, Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY 10032, United States
Author contributions: Ciaccio EJ did the quantitative analyses and wrote the manuscript; Bhagat G, Lewis SK, Green PH reviewed the manuscript and made corrections; Lewis SK provided the clinical data.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board, Columbia University Medical Center.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Edward J Ciaccio, PhD, Celiac Disease Center, Department of Medicine, Columbia University Medical Center, 630 West 168th Street, New York, NY 10032, United States. ciaccio@columbia.edu
Telephone: +1-212-3055447 Fax: +1-212-3420447
Received: April 13, 2016
Peer-review started: April 18, 2016
First decision: May 19, 2016
Revised: June 15, 2016
Accepted: August 15, 2016
Article in press: August 16, 2016
Published online: October 16, 2016

To quantify the presence of villous atrophy in endoscopic images for improved automation.


There are two main categories of quantitative descriptors helpful to detect villous atrophy: (1) Statistical and (2) Syntactic. Statistical descriptors measure the small intestinal substrate in endoscope-acquired images based on mathematical methods. Texture is the most commonly used statistical descriptor to quantify villous atrophy. Syntactic descriptors comprise a syntax, or set of rules, for analyzing and parsing the substrate into a set of objects with boundaries. The syntax is designed to identify and distinguish three-dimensional structures based on their shape.


The variance texture statistical descriptor is useful to describe the average variability in image gray level representing villous atrophy, but does not determine the range in variability and the spatial relationships between regions. Improved textural descriptors will incorporate these factors, so that areas with variability gradients and regions that are orientation dependent can be distinguished. The protrusion syntactic descriptor is useful to detect three-dimensional architectural components, but is limited to identifying objects of a certain shape. Improvement in this descriptor will require incorporating flexibility to the prototypical template, so that protrusions of any shape can be detected, measured, and distinguished.


Improved quantitative descriptors of villous atrophy are being developed, which will be useful in detecting subtle, varying patterns of villous atrophy in the small intestinal mucosa of suspected and known celiac disease patients.

Keywords: Celiac disease, Endoscopy, Small intestine, Video capsule, Villous atrophy

Core tip: Celiac disease is a relatively common ailment throughout the world, affecting approximately 1% of the population. Yet, it is little known and rarely diagnosed. Untreated, it can lead to severe intestinal disturbance, cancer, neurological problems, fertility problems, and other disorders. Villous atrophy of the small intestine is often present in untreated celiac patients. Better quantitative image analysis is important to detect areas of pathology in the small intestine endoscopically. In this study the main approaches for automatically detecting villous atrophy by computerized means are described, which can be helpful to map areas of pathology and determine disease status.