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Right biopsy protocol for microscopic colitis: Reduced workload and carbon footprint while maintaining diagnostic
Edric Leung1,2, Yasir Alshareefy1, Conor Costigan1,3
1Department of Gastroenterology, Tallaght University Hospital, Dublin D24 NR0A, Ireland.
Biopsies from the right colon are highly effective for diagnosing microscopic colitis (MC), even in patchy cases. Current guidelines may be improved by focusing on right-sided biopsies for MC diagnosis.
Area of Science:
- Gastroenterology
- Histopathology
- Endoscopic procedures
Background:
- Microscopic colitis (MC) diagnosis is challenging due to patchy histological findings.
- Current biopsy guidelines for MC may lead to missed diagnoses.
Purpose of the Study:
- To analyze diagnostic biopsies in microscopic colitis patients.
- To optimize colonoscopy biopsy protocols for improved MC detection.
Main Methods:
- Retrospective analysis of 228 index colonoscopies in MC patients over 14 years.
- Data collected included demographics, symptoms, biopsy site, and histological findings.
- Subtypes analyzed were lymphocytic colitis and collagenous colitis.
Main Results:
- Right colon biopsies detected MC in 100% of cases (150/150), with only 2% showing patchy distribution.
- Left colon biopsies detected MC in 92% of cases (158/158).
- 10% of patients with paired biopsies had positive right-sided but negative left-sided results; the reverse was not observed.
Conclusions:
- Biopsies from at least two sites in the right colon, processed in a single container, are supported by this data.
- This approach may improve diagnostic yield for microscopic colitis.
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