Random colonic biopsies in macroscopically normal colonoscopies: is there any benefit? A two‐centre audit of current practice

Abstract

Background: Recent guidelines from the British Society of Gastroenterology published in April 2018, recommended performing random colonic biopsies (RCB) in endoscopically normal colonic mucosa when investigating chronic diarrhoea in adults to rule out microscopic colitis; however, cost effectiveness was not accounted for due to poor evidence base. There is now more evidence that RCBs are of low yield and of significant cost. Methods: A two-centre audit of current practice was conducted at Rockingham General Hospital and Fremantle Hospital in Western Australia, aiming to determine the yield of RCB in macroscopically normal mucosa for microscopic colitis, from 1 January 2009 to 30 June 2018, with comparisons of practice and results between gastroenterologists and general surgeons. Variability in the indications (diarrhoea and non-diarrhoea indications) for RCBs was determined and the cost of consumables, additional endoscopy time and histopathology analysis were calculated. Results: A total of 872 normal colonoscopies with RCBs were included; 48.7% of colonoscopies with RCB were for diarrhoea. Only 1.5% of RCBs were positive for microscopic colitis; 3.1% of patients with diarrhoea had microscopic colitis. Only one patient received pharmacologial treatment as a result of the test. The calculated cost per positive diagnosis of microscopic colitis was $10 862.42. Conclusion: RCBs from normal colonic mucosa have poor yield and are costly. Local guidelines should be updated, so RCBs are performed only in patients with a high degree of suspicion of an organic cause of chronic diarrhoea.

Endoscopic tissue sampling – Part 2: Lower gastrointestinal tract. European Society of Gastrointestinal Endoscopy (ESGE) Guideline

“…Therefore, a full ileocolonoscopy with biopsy sampling of the right hemicolon (one biopsy from the ascending colon and one biopsy from the transverse colon) and left hemicolon (one biopsy from the descending colon and one biopsy from the sigmoid colon) should be performed [11,12]. The biopsies from the right and left hemicolon should be placed in separate containers and labelled as such [7][8][9][10][11][12][13][14]. 4 Inflammatory bowel disease…”

Cost Analysis of Diagnostic Endoscopic Procedures for Chronic Diarrhoea

“…Furthermore, 85.4% of the total expenditure of our cohort of patients primarily resulted in patients either being discharged or receiving symptomatic management. A recent two-centre study which specifically critiques the guidelines published by the British Society of Gastroenterology found that of the 872 colonoscopies performed, only 1.5% random colonic biopsies yielded the diagnosis of microscopic colitis [ 12 ]. The calculated cost per positive diagnosis of microscopic colitis was $10 862.42, leading them to believe that this was not a cost-efficient diagnostic tool.…”