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

Herrod, Philip and Lund, Jonathan 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). pp. 121-124. ISSN 1128-045X

[img]
Preview
PDF - Requires a PDF viewer such as GSview, Xpdf or Adobe Acrobat Reader
Available under Licence Creative Commons Attribution.
Download (749kB) | Preview

Abstract

Background: Random duodenal biopsy to exclude coeliac disease during upper gastrointestinal endoscopy for the investigation of iron defciency 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 beneft 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-efective method of diagnosing coeliac disease and should be replaced

with pre-endoscopy coeliac serology.

Item Type: Article
Keywords: Celiac Disease; Serologic Tests; Endoscopy; Anemia, Iron-Deficiency; biopsy
Schools/Departments: University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine > Division of Medical Sciences and Graduate Entry Medicine
Identification Number: https://doi.org/10.1007/s10151-018-1756-7
Depositing User: Eprints, Support
Date Deposited: 23 Feb 2018 09:58
Last Modified: 10 Apr 2018 14:23
URI: http://eprints.nottingham.ac.uk/id/eprint/49958

Actions (Archive Staff Only)

Edit View Edit View