Tags

Type your tag names separated by a space and hit enter

Variation in small bowel biopsy performance among diverse endoscopy settings: results from a national endoscopic database.
Am J Gastroenterol. 2004 Sep; 99(9):1790-4.AJ

Abstract

BACKGROUND

The diagnostic gold standard for celiac sprue requires performance of small bowel biopsy to identify characteristic mucosal changes. The current biopsy practice among endoscopists for celiac sprue is unknown.

METHODS

The CORI (Clinical Outcomes Research Initiative) national endoscopic database was analyzed to determine the rate of small bowel biopsy in patients undergoing EGD for the evaluation of anemia, iron deficiency without anemia, weight loss, and diarrhea.

RESULTS

Between January 2000 and September 2003, 3,992 patients underwent EGD for the evaluation of anemia, iron deficiency, weight loss, and diarrhea with normal EGD findings. Overall, 438 patients (11%) underwent small bowel biopsy. Small bowel biopsy performance varied with procedure indication: anemia 10%, iron deficiency 7%, weight loss 6%, and diarrhea 19%, p < 0.0001. Biopsy rates declined with advancing patient age; 12% (<50 yr), 12% (50-69 yr), and 9% (> or =70 yr), p= 0.002, and also differed with patient race (12%, Whites vs 8%, non-Whites), p= 0.0007. Biopsy performance varied among endoscopy sites: community (9%), academic (13%), and VAMC (15%), p < 0.0001. Multivariate analysis identified age > or =70 yr (OR: 0.52, p= 0.0007), non-White race (OR: 0.60, p= 0.0007) and an indication of weight loss (OR: 0.60, p= 0.01) to be associated with not performing a biopsy.

CONCLUSION

Among diverse endoscopy sites, the majority of patients with anemia, iron deficiency, weight loss, and diarrhea do not undergo small bowel biopsy at EGD. The diagnosis of celiac sprue should be considered in such cases. Endoscopy provides an opportunity to obtain tissue to diagnose sprue, and should be strongly considered in this setting.

Authors+Show Affiliations

Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN 55905, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

15330920

Citation

Harewood, Gavin C., et al. "Variation in Small Bowel Biopsy Performance Among Diverse Endoscopy Settings: Results From a National Endoscopic Database." The American Journal of Gastroenterology, vol. 99, no. 9, 2004, pp. 1790-4.
Harewood GC, Holub JL, Lieberman DA. Variation in small bowel biopsy performance among diverse endoscopy settings: results from a national endoscopic database. Am J Gastroenterol. 2004;99(9):1790-4.
Harewood, G. C., Holub, J. L., & Lieberman, D. A. (2004). Variation in small bowel biopsy performance among diverse endoscopy settings: results from a national endoscopic database. The American Journal of Gastroenterology, 99(9), 1790-4.
Harewood GC, Holub JL, Lieberman DA. Variation in Small Bowel Biopsy Performance Among Diverse Endoscopy Settings: Results From a National Endoscopic Database. Am J Gastroenterol. 2004;99(9):1790-4. PubMed PMID: 15330920.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Variation in small bowel biopsy performance among diverse endoscopy settings: results from a national endoscopic database. AU - Harewood,Gavin C, AU - Holub,Jennifer L, AU - Lieberman,David A, PY - 2004/8/28/pubmed PY - 2004/10/8/medline PY - 2004/8/28/entrez SP - 1790 EP - 4 JF - The American journal of gastroenterology JO - Am J Gastroenterol VL - 99 IS - 9 N2 - BACKGROUND: The diagnostic gold standard for celiac sprue requires performance of small bowel biopsy to identify characteristic mucosal changes. The current biopsy practice among endoscopists for celiac sprue is unknown. METHODS: The CORI (Clinical Outcomes Research Initiative) national endoscopic database was analyzed to determine the rate of small bowel biopsy in patients undergoing EGD for the evaluation of anemia, iron deficiency without anemia, weight loss, and diarrhea. RESULTS: Between January 2000 and September 2003, 3,992 patients underwent EGD for the evaluation of anemia, iron deficiency, weight loss, and diarrhea with normal EGD findings. Overall, 438 patients (11%) underwent small bowel biopsy. Small bowel biopsy performance varied with procedure indication: anemia 10%, iron deficiency 7%, weight loss 6%, and diarrhea 19%, p < 0.0001. Biopsy rates declined with advancing patient age; 12% (<50 yr), 12% (50-69 yr), and 9% (> or =70 yr), p= 0.002, and also differed with patient race (12%, Whites vs 8%, non-Whites), p= 0.0007. Biopsy performance varied among endoscopy sites: community (9%), academic (13%), and VAMC (15%), p < 0.0001. Multivariate analysis identified age > or =70 yr (OR: 0.52, p= 0.0007), non-White race (OR: 0.60, p= 0.0007) and an indication of weight loss (OR: 0.60, p= 0.01) to be associated with not performing a biopsy. CONCLUSION: Among diverse endoscopy sites, the majority of patients with anemia, iron deficiency, weight loss, and diarrhea do not undergo small bowel biopsy at EGD. The diagnosis of celiac sprue should be considered in such cases. Endoscopy provides an opportunity to obtain tissue to diagnose sprue, and should be strongly considered in this setting. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/15330920/Variation_in_small_bowel_biopsy_performance_among_diverse_endoscopy_settings:_results_from_a_national_endoscopic_database_ L2 - https://doi.org/10.1111/j.1572-0241.2004.40176.x DB - PRIME DP - Unbound Medicine ER -