Introduction The BSG guidelines recommend anti tissue transglutaminase antibody (TTG) testing as a first line test for coeliac disease. Duodenal biopsies (D2) should be performed only after a positive serological test or a negative test with a high clinical suspicion. We aimed to analyse whether the indications for duodenal biopsies and current practise are in keeping with guidelines.

Methods This was a retrospective review of the electronic records of 171 consecutive patients who had had duodenal biopsies.

Results The indications for endoscopy were iron deficiency anaemia (IDA) (51%), weight loss (16%), diarrhoea (3%) and non-specific gastrointestinal symptoms (30%). Seventy (41%) patients had a TTG done prior to endoscopy, 5 patients (2.9%) had a positive TTG prior to a positive D2 biopsy. Sixty-five (38%) patients had D2 biopsies despite a negative TTG. Hundred and one patients (69%) patients had D2 biopsies without any serological testing prior to endoscopy (1 positive biopsy). Nine (5.26%) patients had a TTG checked despite negative histology. The excess cost incurred: for processing biopsies after a negative TTG was £3139.50 and TTG after negative histology was £126.£3430 would have been saved by carrying a TTG test in subjects having a negative biopsy.

Conclusion A significant proportion of duodenal biopsies are done in patients with a negative TTG. The diagnostic yield for coeliac disease in those with a negative TTG was zero. If BSG guidelines were adhered to, £6695 would have been saved in this cohort.

Disclosure of Interest None Declared.