Duodenal Biopsies: Individual or Multiple Samples?

Abstract

We read with great interest the recent American College of Gastroenterology Guidelines Update on Diagnosis and Management of Celiac Disease, coauthored by Rubio-Tapia et al (1) with detailed answers to relevant questions surrounding this evolving topic. When addressing the subject of duodenal biopsies for the diagnosis of celiac disease, they state “It has been recommended by expert opinion that only a single biopsy specimen should be obtained with each pass of the biopsy forceps (2), based on the notion that specimen orientation may be improved (3).” We recently published a study comparing adequacy of tissue obtained for assessment of duodenal pathology using individual and multiple samples and found there was no difference in the quality of the specimen as assessed by the pathologist (4). The ease of taking multiple samples with a single pass of the forceps increases the likelihood of practitioners obtaining sufficient tissue for diagnosis, as well as taking samples from the distal and proximal duodenum, as has been previously recommended. We believe our work, if validated by others, should serve as evidence to support these recommendations, which at the present time can only be stated as expert opinion. CONFLICTS OF INTEREST Guarantor of the article: Carlos Rettally, MD. Specific author contributions: The entire correspondence was prepared by C.R. Financial support: None to report. Potential competing interests: None to report.