1189 Assessing Celiac Disease Biopsy Patterns at Indiana University: A Retrospective Review

Abstract

INTRODUCTION: The histologic abnormalities that are diagnostic of celiac disease (CD) can be patchy. As such, the ACG guidelines recommend that the sampling endoscopist obtain one or two biopsies from the bulb and at least four from the distal duodenum. Previous research has shown gaps in compliance with these recommendations. The aim of the project was to assess how often guideline-recommended biopsy protocol was followed at our institution in evaluating for both incident and prevalent cases of CD. METHODS: Clinical data were systematically abstracted from the electronic medical record of patients who underwent duodenal biopsy at our academic medical center between January 2009 and February 2019. Pathology and endoscopy reports were reviewed. Appropriate biopsy practice was defined as 5 or more specimens submitted for review. Categorical data were analyzed with the Chi-square test. RESULTS: The cohort of biopsied patients included 239 individuals (age range 17-87, median age 43 years old). Of the cohort, a majority were female (72.4%; 173 females, 66 males). Of the patients who presented for EGD with duodenal biopsies, 134 were presenting without a prior diagnosis for evaluation of CD (73.9% females) and 105 were prevalent cases of CD coming for assessment of intestinal healing (70.5% females). A total of 71 incident cases were identified (70.4% females) by 5 female and 15 male endoscopists. Mucosal healing with normal histology was only detected in 42.9% of prevalent individuals [Figure 1]. In the group being evaluated for possible CD 67.16% were biopsied appropriately versus 62.86% of the prevalent cases for follow up (P = 0.49). The number of biopsies obtained ranged from 1-15 (mean 5.68 +/- SD 2.18; median 5, IQR 3-7). Having a female endoscopist evaluate for new diagnosis of CD was associated with better adherence to established biopsy guidelines (OR 3.36, 95% CI 1.35-8.38, P = 0.0092) [Table 1]. CONCLUSION: The results of this cohort-based study indicate that the majority of gastroenterologists at our institution follow guideline-driven biopsy protocol for CD in either suspected or prevalent patients. While these figures are better than historical research, we should strive for improved adherence. Of the patients that we followed with a biopsy-proven diagnosis of CD, we found a surprising number who had not achieved complete histologic healing, emphasizing the importance of follow up endoscopy and appropriate biopsy.