Duodenal Biopsies in Suspected Coeliac Disease and Other Indications for Upper Gastrointestinal Endoscopy
M. Doyle, K. Allen, A. O’Connor
Department of Gastroenterology, Tallaght University Hospital, Tallaght, Dublin 24
Multiple duodenal biopsies (≥4) at upper gastrointestinal (GI) endoscopy are recommended for investigation of suspected coeliac disease (CD). The inclusion of biopsies from the duodenal bulb is also advised, and has been suggested to increase diagnostic yield.
We sought to establish patterns of duodenal sampling during upper GI endoscopy at our institution, and to assess local adherence to guidelines for the diagnosis of CD.
We conducted a retrospective review of histology reports relating to 380 patients who underwent upper GI endoscopy during a 3-month period at a tertiary referral centre. Basic demographic data were collected, in addition to the number of duodenal biopsies performed, the duodenal segment sampled, pre-endoscopy coeliac serology (if available), and the indication for endoscopy. Known CD, and cases where the number of biopsies or the duodenal segment were not specified, were excluded.
348 patients were included; 45.5% (158/348) were male with a mean age of 56.7 years (range: 17 - 91). Suspected CD was the indication in 4.3% (15/348) of upper GI endoscopies, with ≥4 biopsy specimens submitted in 73.3% (11/15), and ≥1 duodenal bulb specimens submitted in 40% (6/15) of these, respectively. The number of duodenal biopsy specimens submitted for analysis was significantly higher in suspected CD compared with all other indications (median number of biopsies: 4 vs 2; p<0.0001).
It is envisaged that these results will inform local initiatives to improve compliance with current guidelines for the diagnosis of CD.