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Duodenal bulb biopsies for diagnosing adult celiac disease: is there an optimal biopsy site?

Abstract：

BACKGROUND:Recent studies highlight the role of duodenal bulb biopsy in the diagnosis of celiac disease. OBJECTIVE:To determine whether a targeted duodenal bulb biopsy in addition to distal duodenal biopsies is the optimal strategy to identify villous atrophy. DESIGN:Prospective cohort study. SETTING:Tertiary-care referral center. PATIENTS:Seventy-seven patients undergoing clinically indicated EGD with duodenal biopsies were recruited. Of these, 28 had newly diagnosed celiac disease and 49 were controls. INTERVENTIONS:At endoscopy, 8 duodenal biopsy specimens were taken: 4 from the second part of the duodenum and 4 quadrantically from the bulb (at the 3-, 6-, 9-, and 12-o'clock positions). MAIN OUTCOME MEASUREMENTS:Increasing the diagnostic yield and detection of the most severe villous atrophy in celiac disease with the addition of a targeted duodenal bulb biopsy. RESULTS:The most severe degree of villous atrophy was detected when distal duodenal biopsy specimens were taken in addition to a duodenal bulb biopsy specimen from either the 9- or 12-o'clock position (96.4% sensitivity; 95% CI, 79.7%-100%). The difference between the 12-o'clock position biopsy and the 3-o'clock position biopsy in detecting the most severe villous atrophy was 92% (24/26) versus 65% (17/26) (P = .02). LIMITATIONS:Small sample and study performed in a tertiary referral center. CONCLUSIONS:This study demonstrates the patchy appearance of villous atrophy that occurs within the duodenum. A targeted duodenal bulb biopsy from either the 9- or 12-o'clock position in addition to distal duodenal biopsies may improve diagnostic yields by detecting the most severe villous atrophy within the duodenum.

journal_name

Gastrointest Endosc

journal_title

Gastrointestinal endoscopy

authors

Kurien M,Evans KE,Hopper AD,Hale MF,Cross SS,Sanders DS

doi

10.1016/j.gie.2012.02.025

subject

Has Abstract

pub_date

2012-06-01 00:00:00

pages

1190-6

issue

6

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(12)00190-3

journal_volume

75

pub_type

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