Adherence to Endoscopy Biopsy Guidelines for Celiac Disease

Area of Science:

• Pediatric Gastroenterology
• Gastrointestinal Pathology
• Celiac Disease Diagnosis

Background:

• Celiac disease (CD) diagnosis relies on histologic evaluation of duodenal biopsies.
• Current guidelines recommend multiple biopsies from the bulb and distal duodenum due to patchy disease.
• Adherence to biopsy guidelines is low among adult gastroenterologists, with limited data on pediatric practices.

Purpose of the Study:

• To compare endoscopic biopsy practices in pediatric gastroenterologists for children with and without histologically confirmed celiac disease.
• To assess adherence to recommended biopsy numbers and sites in pediatric celiac disease evaluations.

Main Methods:

• Retrospective review of esophagogastroduodenoscopies (EGDs) in children over 13 months.
• Comparison of biopsy site and number between children with confirmed CD and age-matched controls without CD.
• Analysis of endoscopy and histology reports to record biopsy details.

Main Results:

• Children with CD (n=98) received more biopsies (5.9 ± 1.6) than controls (n=103, 3.6 ± 1.2) (P<0.0001).
• 80.5% of CD patients had ≥5 biopsies versus 11.7% of controls (P<0.0001).
• Bulb biopsies were documented in only 10% of CD patients, and none of the controls.

Conclusions:

• Pediatric gastroenterologists at the study center generally obtain adequate biopsy numbers for confirmed celiac disease.
• Bulb biopsies are infrequently documented in pediatric celiac disease evaluations.
• Insufficient biopsies, particularly from the bulb, may contribute to missed celiac disease diagnoses.