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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.
Background:
Histological findings of microscopic colitis (MC) are patchy, with potential for missed diagnoses. While guidelines recommend biopsies from the right and left sides of the colon, the optimal approach remains uncertain.
Aim:
To interrogate diagnostic biopsies in a cohort of patients with confirmed MC with a view to improving biopsy protocols.
Methods:
We conducted a retrospective study of index colonoscopies in patients with MC over a 14-year period. We recorded demographics, symptoms, total number and location of biopsies, and whether they revealed features of lymphocytic or collagenous colitis.
Results:
A total of 228 index colonoscopies were included: 64% (145/228) lymphocytic colitis and 36% (83/228) collagenous colitis. The median age at diagnosis was 60 (interquartile range: 48-72) years, with 27% (61/228) aged < 50 years. Overall, 71% (162/228) of the patients were female, similar across subtypes. Males were older at diagnosis than females (62 vs 56, P = 0.03). Symptoms were known in 86% of patients (196/228), of whom 98% (192/196) had diarrhea. Among 150 cases with biopsies from the right colon, MC features were present in the right-colon specimens in 100%, with a patchy distribution in only 2% (3/150). In contrast, among 158 cases with biopsies from the left colon, MC features were present in the left-colon specimens in 92%. Among cases with paired right and left biopsies, 10% (13/136) had positive right-sided biopsies with negative left-sided biopsies; the converse was never observed. Regarding specimen containers, those from the left colon were more likely to be negative [9% (17/199) vs 2% (4/209), odds ratio: 4.79, P = 0.0025].
Conclusion:
In the era of green endoscopy, our data support a protocol of taking biopsies from at least two sites in the right colon only, processed in a single container.
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