Is Endoscopic Assessment of the Esophagus and Stomach Enough to Determine the Need for Biopsy at These Sites in Pediatric Patients Undergoing Endoscopy for Elevated TTG?

Abstract

Objectives The goal of our study was to determine whether visual assessment of the esophagus and stomach could predict abnormal histology and determine the frequency of interventions based on biopsies in patients undergoing endoscopy for elevated tissue transglutaminase immunoglobulin A antibody (TTG). Methods Pathology records were searched for patients with biopsy performed for elevated TTG. Pathology report, endoscopy report, and follow-up were obtained and slides from the duodenum reviewed. Pathology was considered gold standard for sensitivity and specificity calculations. Results 240 patients were included. 215 patients had esophageal biopsies performed. Esophageal endoscopic visual assessment had sensitivity of 47% and specificity of 93% for abnormal histology. 16(7%) patients had therapy or referral related to results and, of these, 6(38%) had visually normal endoscopy. 237 biopsies were performed of stomach. Gastric endoscopic visual assessment had a sensitivity and specificity of 20% and 87%. 24(10%) patients had therapy based on findings and, of these, 12 (50%) had visually normal endoscopy. Conclusions Endoscopic assessment of esophagus and stomach has low sensitivity and high specificity for pathologic abnormalities when indication for endoscopy is elevated TTG. When endoscopy is visually normal clinical interventions based on biopsy are rare, and foregoing biopsy may be considered.

Upper Gastrointestinal Tract Associated Lesions in Patients with Newly Diagnosed Celiac Disease

“…However, some of the findings were clinically relevant, as their detection involved a change in management in about one-third of patients-whether establishing the need for endoscopic follow-up (e.g., metaplastic, atrophic gastritis, gastric ulcers), high dose proton pump inhibitors (e.g., ulcers), testing and eradication therapy for Helicobacter pylori infection, or further investigations (e.g., subepithelial lesions). Concurring results have been reported by Pacheco et al, who analyzed the frequency of interventions based on esophageal and gastric biopsies in patients undergoing endoscopy for elevated tTG: 7% of patients had therapy or referral related to esophageal pathology and 10% to gastric pathology [58]. A biopsy avoidance strategy for diagnosing CD would miss the clinical decisions driven by endoscopy findings, in a patient in whom upper endoscopy would otherwise not be performed, if not for the suspicion of CD.…”