Normal rectal mucosa. Should we biopsy?
OBJECTIVE
To determine the practice of routine rectal biopsy in the United Kingdom, and assess the diagnostic yield and complications of rectal biopsy in patients presenting with diarrhea.


METHODS
A postal questionnaire was sent to consultant members of the British Society of Gastroenterology. An audit of the diagnostic yield and complications resulting from routine biopsy of normal looking rectal mucosa in patients presenting with diarrhea was performed.


RESULTS
Ninety five (35%) consultants "nearly always" biopsy normal looking mucosa, with a further 56 (20%) taking a biopsy in more than fifty percent of cases. Fifty five (20%) almost never biopsy if the mucosa looks normal, with 68 (20%) taking a biopsy less than fifty percent of the time. Biopsies were taken from 50 patients referred with diarrhea whose rectal mucosa looked normal. Abnormal histology was reported in 11 (22%) cases. The rectal biopsy led to a positive diagnosis and change in management in 4 (8%) cases. The remaining biopsies showed minor inflammatory changes that were not considered clinically important. One significant complication occurred due to rectal biopsy.


CONCLUSIONS
Clinicians disagree on the value of routine rectal biopsy in the investigation of diarrhea. In patients presenting with diarrhea, the diagnostic yield from biopsy of normal looking rectal mucosa is low. Life threatening complications can occur and in unselected patients routine biopsy should not be performed.
Robinson
R J
RJ
Leicester General Hospital, United Kingdom.
Stone
M
M
Mayberry
J F
JF
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000009:adverse effects / Q000706:statistics & numerical data; D003625:Data Collection; D003967:Diarrhea / Q000473:pathology*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000473:pathology*