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Random duodenal biopsy to exclude coeliac disease as a cause of anaemia is not cost-efective and should be replaced with universally performed pre-endoscopy serology in patients on a suspected cancer pathway.
Tech Coloproctol. 2018 02; 22(2):121-124.TC

Abstract

BACKGROUND

Random duodenal biopsy to exclude coeliac disease during upper gastrointestinal endoscopy for the investigation of iron deficiency anaemia remains a common procedure, but is expensive and time-consuming. Serological investigation for coeliac disease is also recommended, having excellent accuracy with the added benefit of lower cost. This study sought to examine the utility of duodenal biopsy and coeliac serology in the diagnosis of coeliac disease.

METHODS

A prospectively maintained database was interrogated to identify all patients having upper gastrointestinal endoscopy for the investigation of anaemia between January 01, 2016, and December 31, 2016.

RESULTS

Of the 1131 patients having an endoscopy, coeliac serology was measured in only 412 (36%) and was positive in 9 cases (2%), leading to 6 histological diagnoses of coeliac disease and 3 false positives. Two-hundred and seventy-four patients with negative serology had biopsies taken which were all negative. Only 2/451 (0.4%) patients who had biopsies performed in the absence of a serology test were histologically positive for coeliac disease. The cost per diagnosis of a case of coeliac disease in those with either negative or absent coeliac serology was £18,839 (US$25,244, €21,196).

CONCLUSIONS

Random duodenal biopsy is not a cost-effective method of diagnosing coeliac disease and should be replaced with pre-endoscopy coeliac serology.

Authors+Show Affiliations

Department of Surgery, Royal Derby Hospital, Derby, DE22 3NE, UK. pherrod@nhs.net. Division of Medical Sciences and Graduate Entry Medicine, Royal Derby Hospital, University of Nottingham, Derby, UK. pherrod@nhs.net.Department of Surgery, Royal Derby Hospital, Derby, DE22 3NE, UK. Division of Medical Sciences and Graduate Entry Medicine, Royal Derby Hospital, University of Nottingham, Derby, UK.

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

29476446

Citation

Herrod, P J J., and J N. Lund. "Random Duodenal Biopsy to Exclude Coeliac Disease as a Cause of Anaemia Is Not Cost-efective and Should Be Replaced With Universally Performed Pre-endoscopy Serology in Patients On a Suspected Cancer Pathway." Techniques in Coloproctology, vol. 22, no. 2, 2018, pp. 121-124.
Herrod PJJ, Lund JN. Random duodenal biopsy to exclude coeliac disease as a cause of anaemia is not cost-efective and should be replaced with universally performed pre-endoscopy serology in patients on a suspected cancer pathway. Tech Coloproctol. 2018;22(2):121-124.
Herrod, P. J. J., & Lund, J. N. (2018). Random duodenal biopsy to exclude coeliac disease as a cause of anaemia is not cost-efective and should be replaced with universally performed pre-endoscopy serology in patients on a suspected cancer pathway. Techniques in Coloproctology, 22(2), 121-124. https://doi.org/10.1007/s10151-018-1756-7
Herrod PJJ, Lund JN. Random Duodenal Biopsy to Exclude Coeliac Disease as a Cause of Anaemia Is Not Cost-efective and Should Be Replaced With Universally Performed Pre-endoscopy Serology in Patients On a Suspected Cancer Pathway. Tech Coloproctol. 2018;22(2):121-124. PubMed PMID: 29476446.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Random duodenal biopsy to exclude coeliac disease as a cause of anaemia is not cost-efective and should be replaced with universally performed pre-endoscopy serology in patients on a suspected cancer pathway. AU - Herrod,P J J, AU - Lund,J N, Y1 - 2018/02/23/ PY - 2017/10/23/received PY - 2017/12/20/accepted PY - 2018/2/25/pubmed PY - 2018/10/5/medline PY - 2018/2/25/entrez KW - Anaemia KW - Biopsy KW - Celiac disease KW - Colorectal cancer KW - Endoscopy KW - Iron deficiency KW - Serologic tests SP - 121 EP - 124 JF - Techniques in coloproctology JO - Tech Coloproctol VL - 22 IS - 2 N2 - BACKGROUND: Random duodenal biopsy to exclude coeliac disease during upper gastrointestinal endoscopy for the investigation of iron deficiency anaemia remains a common procedure, but is expensive and time-consuming. Serological investigation for coeliac disease is also recommended, having excellent accuracy with the added benefit of lower cost. This study sought to examine the utility of duodenal biopsy and coeliac serology in the diagnosis of coeliac disease. METHODS: A prospectively maintained database was interrogated to identify all patients having upper gastrointestinal endoscopy for the investigation of anaemia between January 01, 2016, and December 31, 2016. RESULTS: Of the 1131 patients having an endoscopy, coeliac serology was measured in only 412 (36%) and was positive in 9 cases (2%), leading to 6 histological diagnoses of coeliac disease and 3 false positives. Two-hundred and seventy-four patients with negative serology had biopsies taken which were all negative. Only 2/451 (0.4%) patients who had biopsies performed in the absence of a serology test were histologically positive for coeliac disease. The cost per diagnosis of a case of coeliac disease in those with either negative or absent coeliac serology was £18,839 (US$25,244, €21,196). CONCLUSIONS: Random duodenal biopsy is not a cost-effective method of diagnosing coeliac disease and should be replaced with pre-endoscopy coeliac serology. SN - 1128-045X UR - https://www.unboundmedicine.com/medline/citation/29476446/Random_duodenal_biopsy_to_exclude_coeliac_disease_as_a_cause_of_anaemia_is_not_cost_efective_and_should_be_replaced_with_universally_performed_pre_endoscopy_serology_in_patients_on_a_suspected_cancer_pathway_ L2 - https://dx.doi.org/10.1007/s10151-018-1756-7 DB - PRIME DP - Unbound Medicine ER -