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Jejunal Villous Biopsy – Diagnosis and Significance

A jejunal villous biopsy is a diagnostic procedure in which a small tissue sample is taken from the lining of the jejunum to examine the intestinal villi. It is the gold standard for diagnosing coeliac disease and other malabsorption disorders.

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Things worth knowing about "Jejunal Villous Biopsy"

A jejunal villous biopsy is a diagnostic procedure in which a small tissue sample is taken from the lining of the jejunum to examine the intestinal villi. It is the gold standard for diagnosing coeliac disease and other malabsorption disorders.

What is a Jejunal Villous Biopsy?

A jejunal villous biopsy is a diagnostic procedure in which a small sample of tissue is taken from the mucosa (inner lining) of the jejunum – the middle section of the small intestine. The purpose is to examine the intestinal villi under a microscope. These finger-like projections of the intestinal lining are essential for absorbing nutrients from food.

Today, the procedure is most commonly performed during an upper gastrointestinal endoscopy (gastroscopy), in which a flexible tube (endoscope) is passed through the mouth, down the oesophagus and stomach, and into the small intestine. Historically, the biopsy was also performed using capsule biopsy devices such as the Watson capsule.

When is a Jejunal Villous Biopsy Performed?

The biopsy is indicated when there is suspicion of conditions that damage the intestinal villi. Common indications include:

Coeliac disease: an autoimmune condition in which gluten causes villous atrophy and inflammation
Whipple disease: a rare bacterial infection affecting the intestine
Giardiasis (Lambliasis): an intestinal infection caused by the parasite Giardia lamblia
Tropical sprue: a malabsorption disorder found in tropical regions
Hypogammaglobulinaemia with intestinal involvement
Unexplained malabsorption or chronic diarrhoea
Suspected intestinal lymphangiectasia

How is the Procedure Performed?

The biopsy is routinely performed during a gastroscopy or enteroscopy under mild sedation. Using small biopsy forceps, multiple tissue samples are taken from the distal duodenum or proximal jejunum. The specimens are then processed in a laboratory and assessed using standardised grading systems.

Histological Classification According to Marsh-Oberhuber

For evaluating changes typical of coeliac disease, the Marsh-Oberhuber classification is widely used:

Marsh 0: Normal mucosa
Marsh 1: Increased intraepithelial lymphocytes
Marsh 2: Crypt hyperplasia in addition to increased lymphocytes
Marsh 3a/3b/3c: Partial to total villous atrophy

Preparation and Risks

Patients are required to fast before the procedure – typically no solid food for 6 hours and no clear fluids for 2 hours. Blood-thinning medications may need to be temporarily discontinued beforehand.

The jejunal villous biopsy is a safe and well-established procedure. Rare complications may include:

Minor bleeding at the biopsy site
Very rarely: perforation of the intestinal wall
Reactions to the sedative medication

Results and Clinical Significance

The biopsy results provide important information about the condition of the intestinal mucosa. If villous atrophy is confirmed, targeted treatment such as a gluten-free diet for coeliac disease or other specific therapies can be initiated. The jejunal villous biopsy remains the gold standard in the diagnosis of coeliac disease and other malabsorption disorders.

References

Oberhuber G, Granditsch G, Vogelsang H. The histopathology of coeliac disease: time for a standardized report scheme for pathologists. European Journal of Gastroenterology and Hepatology. 1999;11(10):1185-1194.
Ludvigsson JF et al. The Oslo definitions for coeliac disease and related terms. Gut. 2013;62(1):43-52.
Rubio-Tapia A et al. ACG Clinical Guidelines: Diagnosis and Management of Celiac Disease. American Journal of Gastroenterology. 2013;108(5):656-676.

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