Is there a case for routine duodenal biopsy at gastroscopy or is a targeted approach adequate?

Introduction

Small-bowel disease may be detected by performing a duodenal biopsy. For this reason, current British Society of Gastroenterology (BSG) guidelines recommend that a duodenal biopsy is taken at the time of gastroscopy if there is evidence of anemia or malabsorption (diarrhea) [1] [2]. However, it has been demonstrated that duodenal biopsy rates in “real clinical practice” may vary greatly, even when the indications seem appropriate (i. e., anemia or suspicion of malabsorption). Previous investigators have reported that duodenal biopsy rates vary from 30.9 % to 74 % [3].

In relation specifically to appropriate subgroup indications, the duodenal biopsy rate has been disappointing: only 7 % – 44 % of patients with anemia and only 6 % – 19 % of those with weight loss and diarrhea have had a duodenal biopsy performed [4] [5]. We and others have previously reported that 13.6 % of patients diagnosed with celiac disease had undergone a gastroscopy without a duodenal biopsy within the previous 5 years [6]. As a result of our failure to perform duodenal biopsy appropriately, many centers internationally now suggest or recommend the practice of routine duodenal biopsy [3] [7] [8] [9] [10]. For this reason, we aimed to assess whether a policy of routine duodenal biopsy showed a significantly higher yield of small-bowel disease compared to our current duodenal biopsy practice or to the case when recommendations are accurately followed.

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