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. A total of 191 patients underwent upper end oscopy for the purpose of obtaining duodenal biopsy specimens. The findings were assessed independently by 3 experienced observers by using a commercially avail able, high-resolution, high-magnifying (×2) videoendoscope. The duodenal villous profile was determined by endoscopic magnification and by endoscopic magnifi cation after filling the duodenum with water. With both endoscopic magnification and endoscopic magnification after filling the duodenum with water, villous pat terns were scored as the following: definitely present, partially present, or de finitely absent. Villous patterns also were histopathologically scored as the fo llowing: normal, partial villous pattern, or total villous atrophy. Interobserver variability was excellent (κ= 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%. High-resolution magnifying upper endoscopy can reliably predict the presence or the absence of duodenal villi. New study videoendoscopes potentially may visualize duodenal villi. This study compared endoscopic findings with this type of instrument to the histopathologic evaluation of duodenal villi. A total of 191 patients underwent upper upper oscopy for the purpose of obtaining duodenal biopsy specimens. by 3 experienced observers by using a commercially available avail able, high-resolution, high-magnification (× 2) video endoscope. The duodenal villous profile was determined by endoscopic magnification and by endoscopic magnifi cation after filling the duodenum with water. With both endoscopic magnification and endoscopic magnification after filling the duodenum with water, villous pat terns were scored as the following: definitely present, partially present, or de finitely absent. Villous patterns also were histopathologically scored as the fo llowing: normal, partial villous pattern, or total villous atrophy . Interobserver variability was excellent (κ = 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 respectively 95%, 99%, 95%, and 99%, respectively; the respective values ​​of endoscopic magnification after filling the duodenum with water were 95%, 98%, 92%, and 99%. High-resolution magnifying upper endoscopy sure securely predict the presence or the absence of duodenal villi.