Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 28, 2015; 21(24): 7495-7499
Published online Jun 28, 2015. doi: 10.3748/wjg.v21.i24.7495
Low yield of routine duodenal biopsies for evaluation of abdominal pain
Sterling M Dubin, Wilson T Kwong, Denise Kalmaz, Thomas J Savides
Sterling M Dubin, Wilson T Kwong, Denise Kalmaz, Thomas J Savides, Department of Medicine, Division of Gastroenterology, University of California San Diego, La Jolla, CA 92093-0956, United States
Author contributions: Dubin SM, Kwong WT, Kalmaz D and Savides TJ performed data acquisition, data analysis, and manuscript preparation; Kwong WT performed data acquisition, data analysis, manuscript revision; Kalmaz D performed manuscript revision; and Savides TJ created the study concept and manuscript revision.
Ethics approval: The study was reviewed and approved by the University of California San Diego Institutional Review Board.
Informed consent: This was a retrospective review of medical records. A waiver for consent was obtained via Institutional Review Board approval.
Conflict-of-interest: There are no conflicts of interest.
Data sharing: Technical appendix, statistical code, and dataset available from the corresponding author at sterling.dubin@gmail.com. Consent was not obtained but the presented data are anonymized and risk of identification is low. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sterling M Dubin, MD, Department of Medicine, Division of Gastroenterology, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0956, United States. sterling.dubin@gmail.com
Telephone: +11-619-5436287 Fax: +11-619-5436529
Received: January 21, 2015
Peer-review started: January 22, 2015
First decision: February 10, 2015
Revised: February 23, 2015
Accepted: April 16, 2015
Article in press: April 17, 2015
Published online: June 28, 2015
Processing time: 158 Days and 9.8 Hours
Abstract

AIM: To determine the yield of biopsying normal duodenal mucosa for investigation of abdominal pain.

METHODS: This is a retrospective chart review of consecutive patients who underwent esophagogastroduodenoscopy (EGD) with duodenal biopsies of normal appearing duodenal mucosa for an indication that included abdominal pain. All the patients in this study were identified from an electronic endoscopy database at a single academic medical center and had an EGD with duodenal biopsies performed over a 4-year period. New diagnoses that were made as a direct result of duodenal biopsies were identified. All duodenal pathology reports and endoscopy records were reviewed for indications to perform the examination as well as the findings; all the medical records were reviewed. Exclusion criteria included age less than 18 years, duodenal mass, nodule, or polyp, endoscopic duodenitis, duodenal scalloping, known celiac disease, positive celiac serology, Crohns disease, or history of bone marrow transplant. Information was collected in a de-identified database with pertinent demographic information including human immunodeficiency virus (HIV) status, and descriptive statistics were performed.

RESULTS: About 300 patients underwent EGD with biopsies of benign appearing or normal appearing duodenal mucosa. The mean age of patients was 44.1 ± 16.8 years; 189 of 300 (63%) were female. A mean of 4.3 duodenal biopsies were performed in each patient. In the subgroup of patients with abdominal pain without anemia, diarrhea, or weight loss the mean age was 43.4 ± 16.3 years. Duodenal biopsies performed for an indication that included abdominal pain resulting in 4 new diagnoses (3 celiac disease and 1 giardiasis) for an overall yield of 1.3%. 183 patients with abdominal pain without anemia, diarrhea, or weight loss (out of the total 300 patients) underwent duodenal biopsy of duodenal mucosa resulting in three new diagnoses (two cases of celiac disease and one giardiasis) for a yield of 1.6%. Duodenal biopsies of 19 HIV patients presenting for evaluation of abdominal pain did not reveal any new diagnoses. Information pertaining to new diagnoses is provided.

CONCLUSION: Routine biopsy of normal appearing duodena in patients with abdominal pain should be reserved for those with a high pre-test probability given its low diagnostic yield.

Keywords: Duodenum; Celiac disease; Esophagogastroduodenoscopy; Abdominal pain; Anemia; Iron deficiency anemia; Diarrhea

Core tip: Duodenal biopsy is commonly performed, yet the diagnostic yield of routine duodenal biopsy of normal appearing duodenal mucosa for the evaluation of abdominal pain is unclear. This retrospective chart review of 300 consecutive patients with duodenal biopsy of normal appearing mucosa performed for evaluation of abdominal pain found a diagnostic yield of 1.3%. There were 3 new diagnoses of celiac disease and one of giardiasis. Routine biopsy of normal appearing duodenal mucosa during esophagogastroduodenoscopy should be reserved for patients with a high pretest probability of duodenal pathology given a low diagnostic yield.