Table of Contents
ISRN Endoscopy
Volume 2013 (2013), Article ID 623936, 5 pages
http://dx.doi.org/10.5402/2013/623936
Research Article

Routine Duodenal Biopsies in the Absence of Endoscopic Markers of Celiac Disease Are Not Useful: An Observational Study

1Department of Gastroenterology, Cleveland Clinic Florida, Weston, FL 33331, USA
2Gastroenterology of the Rockies, Boulder, CO 80303, USA
3Gastroenterology Consultants, IMA Greenville Hospital System, Greenville, SC 29607, USA
4Department of Pathology, Cleveland Clinic Florida, Weston, FL 33331, USA

Received 5 June 2013; Accepted 2 July 2013

Academic Editors: P. Born, B. Braden, G. Larciprete, and M. Sewitch

Copyright © 2013 Fernando Castro et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. European studies have shown the utility of limiting endoscopic biopsies to diagnose celiac disease (CD) to patients that have high-risk symptoms or present with positive serology. However, many centers in the U.S. have open access endoscopy. Patients are referred without prior serologic testing, and endoscopists often decide whether or not to biopsy at the time of procedure. Aims. Evaluate the yield of duodenal biopsies for the diagnosis of CD in patients undergoing upper endoscopy without prior serologic testing. Methods. This retrospective study evaluated the frequency of CD diagnosis based duodenal biopsies. Researchers were interested in the yield of endoscopic stigmata findings in patients with high-risk symptoms versus low risk. Results. Eight hundred and ten patients met entry criteria at the Cleveland Clinic Florida between 2004 and 2008; 320 presented with high-risk symptoms; and 490 low risk. Sixty-one (7.5%) displayed endoscopic stigmata, and 10/61 (16.3%) were diagnosed with CD. Only patients who exhibited endoscopic stigmata were later diagnosed based on histologic findings. The presence of endoscopic stigmata greatly increased the probability of diagnosing CD, with a positive likelihood ratio of 15.6. Conclusions. When performing upper endoscopy without known serological markers for CD, clinicians should limit duodenal biopsies to patients with high-risk symptoms or endoscopic stigmata.