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Normal rectal mucosa. Should we biopsy?

R J Robinson1, M Stone, J F Mayberry

  • 1Leicester General Hospital, United Kingdom.

Hepato-Gastroenterology
|May 1, 1997
PubMed
Summary
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Routine rectal biopsy for diarrhea has low diagnostic yield and carries risks. Clinicians have differing practices, but routine biopsy of normal-appearing rectal mucosa is not recommended due to low diagnostic yield and potential complications.

Area of Science:

  • Gastroenterology
  • Colorectal Surgery
  • Diagnostic Procedures

Background:

  • Practices regarding routine rectal biopsy in the UK for diarrhea investigation vary among gastroenterologists.
  • There is a lack of consensus on the diagnostic utility and complication rates associated with this procedure.

Purpose of the Study:

  • To ascertain the current practice patterns of routine rectal biopsy in the United Kingdom.
  • To evaluate the diagnostic yield and complication profile of rectal biopsies performed in patients presenting with diarrhea.

Main Methods:

  • A nationwide postal survey was distributed to consultant members of the British Society of Gastroenterology.
  • An audit was conducted on the diagnostic yield and complications of routine rectal biopsies from patients with diarrhea and normal-appearing rectal mucosa.

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Main Results:

  • A significant proportion of consultants (55%) routinely perform rectal biopsies on normal-appearing mucosa.
  • In patients with diarrhea and normal mucosa, abnormal histology was found in 22% of biopsies, with only 8% leading to a positive diagnosis and management change.
  • One significant complication was reported.

Conclusions:

  • There is considerable disagreement among clinicians regarding the value of routine rectal biopsy for diarrhea.
  • The diagnostic yield of rectal biopsy in patients with diarrhea and normal-appearing mucosa is low.
  • Routine rectal biopsy in unselected patients with diarrhea is not advised due to low yield and potential for serious complications.