Endoscopic biopsy technique in the diagnosis of celiac disease: One bite or two?

Background The diagnosis of celiac disease is dependent on the quality of biopsy specimens obtained at EGD. Endoscopists may obtain a single- or double-biopsy specimen with each pass of the forceps. Objective To compare the quality of biopsy specimens obtained with the single-biopsy and double-biops...

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Bibliographic Details
Published in:Gastrointestinal endoscopy 2015-05, Vol.81 (5), p.1228-1233
Main Authors: Latorre, Melissa, MD, Lagana, Stephen M., MD, Freedberg, Daniel E., MD, Lewis, Suzanne K., MD, Lebwohl, Benjamin, MD, Bhagat, Govind, MD, Green, Peter H.R., MD
Format: Article
Language:English
Subjects:
Adult
Aged
Biopsy - methods
Biopsy - standards
Celiac Disease - pathology
Duodenum - pathology
Endoscopy
Female
Gastroenterology and Hepatology
Humans
Male
Middle Aged
Prospective Studies
Severity of Illness Index
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Summary:Background The diagnosis of celiac disease is dependent on the quality of biopsy specimens obtained at EGD. Endoscopists may obtain a single- or double-biopsy specimen with each pass of the forceps. Objective To compare the quality of biopsy specimens obtained with the single-biopsy and double-biopsy techniques. Design Prospective cohort study. Setting U.S. tertiary-care university hospital. Patients Patients undergoing upper endoscopy with confirmed, suspected, or unknown celiac disease status. Interventions Four biopsy specimens from the second portion of the duodenum: 2 by using the single-biopsy technique (1 bite per pass of the forceps) and an additional 2 by using the double-biopsy technique (2 bites per pass of the forceps). Specimens were blindly reviewed to determine orientation, consecutive crypt-to-villous units, and Marsh score. Main Outcome Measurements Proportion of well-oriented biopsy specimens. Results Patients (N = 86) were enrolled, 47% with known celiac disease, 36% with suspected celiac disease, and 17% with an unknown celiac disease status. Well-oriented biopsy specimens were noted in 66% of patients with the single-biopsy technique and 42% of patients with the double-biopsy technique ( P  < .01). Analysis of matched pairs showed improved orientation with the single-biopsy technique (odds ratio 3.1; 95% confidence interval, 1.5-7.1; P  < .01). This persisted in subgroup analysis of patients with known celiac disease ( P  = .02), villous atrophy ( P  = .02), and a final diagnosis of celiac disease ( P  < .01). Limitations A single-center trial. Conclusion The single-biopsy technique improves the yield of well-oriented duodenal biopsy specimens. Endoscopists should consider taking only 1 biopsy specimen per pass of the forceps in patients undergoing biopsies of the duodenal mucosa.
ISSN:0016-5107
1097-6779
DOI:10.1016/j.gie.2014.10.024