Introduction By and the large, the most common indication for obtaining biopsy of the 2nd part of the duodenum is in the diagnosis of coeliac disease. We wanted to identify the diagnostic yield of duodenal biopsies at upper GI endoscopy.
Methods We obtained clinical details of 500 patients who had duodenal biopsies taken at upper GI endoscopy (UGIE). This was provided by our local histo-pathology department. These included patients who had UGIE from October 2011 till September 2012.
We excluded indications related to coeliac follow up and suspected malignancy (n = 31). We collected data that included age of the patient, indication of the biopsy, findings at endoscopy and histology. We also looked at our results server to see if TTGs were sent for these biopsies.
Results Duodenal biopsies were taken to rule out coeliac disease in the context of a variety of symptoms: mainly iron-deficiency or other unspecified anaemia, but also chronic or intermittent diarrhoea, unexplained GI symptoms including nausea and vomiting, fatigue, abdominal pain and distension and weight loss.
Of the 469 biopsies, 89% (n = 416) were reported as normal at histology and 11% (n = 53) were reported as being abnormal.
84% (n = 45) of the abnormal biopsies were non specific in nature. Only 11.3% (n = 6) of the abnormal biopsies were diagnosed as coeliac. A further 2 patients were diagnosed as coeliac disease after further clinical evaluation.
Of the 469 samples, 34% (n = 161) of patients had TTG serology was sent prior to biopsy. Only 50% (n = 3) of those diagnosed with coeliac disease in this study had TTG done prior to biopsy.
1.7%(n = 8) of patients who had duodenal biopsies had a conclusive diagnosis of coeliac disease.
Only 0.4% (n = 2) of patients who were TTG negative were diagnosed with coeliac disease based on histology and clinical correlation. There were no falsely positive TTG.
Conclusion The diagnostic yield of duodenal biopsies is low. It may be more cost-effective if we limit biopsies after being guided by tissue transglutamiase (TTG).
Disclosure of Interest None Declared.
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