Duodenal biopsies for the diagnosis of coeliac disease: Are we adhering to current guidance?

Abstract

Background: The British Society of Gastroenterology guidelines recommend taking at least four duodenal biopsy specimens at the time of upper gastrointestinal (UGI) endoscopy if coeliac disease (CD) is suspected and it has been shown to increase the diagnostic yield of CD. We assessed the compliance to these guidelines within our institution. We then applied measures to improve our compliance rate and assessed the resulting impact on our diagnostic rate of CD. Methods: We performed a retrospective audit of electronic records for all patients, with no prior diagnosis of CD, who underwent UGI endoscopy with duodenal biopsies between August 2014 and May 2015. We implemented measures to raise awareness among endoscopy users at our institution and carried out a reaudit between February and May 2016. Results: 924 patients were found to be eligible in the first part of the study and 278 in the second part. The proportion of patients who had ≥4 biopsy specimens submitted increased from 21.9% to 60.8% ( p<0.001). The diagnostic rate of CD increased from 3.5% in the audit group to 7.6% in the reaudit group ( p=0.004). A positive serology result and suspected CD as an indication for biopsy were found to be independent predictors of the likelihood of complying with guidelines. Conclusions: Our study suggests that taking <4 duodenal biopsy specimens to assess for the presence of CD may lead to the diagnosis of CD being missed. Simple measures can improve the local compliance rate to current guidelines.