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The colon, or large intestine, is the final segment of the digestive system. Its primary functions include absorbing water and vitamins produced by gut bacteria and transforming waste from liquid to solid to form stool. In adults, the large intestine is approximately 5 feet long and consists of four main sections:
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The endoscopically normal colon: when is mapping biopsy histopathologically justifiable?

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Area of Science:

  • Gastroenterology
  • Histopathology
  • Colorectal Cancer Screening

Background:

  • Mapping biopsies of endoscopically normal colons are debated, impacting histopathology workload.
  • Managing demand for pathological testing is a healthcare priority.

Purpose of the Study:

  • To determine the diagnostic yield of mapping biopsies in endoscopically normal colons.
  • To identify criteria for safely streamlining biopsy practices.

Main Methods:

  • Retrospective audit of 717 cases over 10 months.
  • Correlation of histopathology results with endoscopy reports.
  • Anonymised data analysis.

Main Results:

  • 308 cases (43%) had endoscopically normal colons.
  • 9.7% of these normal cases showed pathological abnormalities.
  • Microscopic colitis was found in 2.9% of cases; 66.7% of abnormal cases presented with change in bowel habit.

Conclusions:

  • Pathological abnormalities in normal colons are most common in patients with altered bowel habits or inflammatory bowel disease.
  • Routine mapping biopsies for other indications (e.g., rectal bleeding, anemia) have low yield.
  • Streamlining biopsy based on referral reason or symptoms can optimize histopathological demand management.