title: Endoscopic biopsy technique in the diagnosis of celiac disease: one bite or two?
abstract: BACKGROUND
  The diagnosis of celiac disease is dependent on the quality of biopsy specimens obtained at EGD. Endoscopists may obtain a single- or double-biopsy specimen with each pass of the forceps.
  
  
  OBJECTIVE
  To compare the quality of biopsy specimens obtained with the single-biopsy and double-biopsy techniques.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  U.S. tertiary-care university hospital.
  
  
  METHODS
  Patients undergoing upper endoscopy with confirmed, suspected, or unknown celiac disease status.
  
  
  METHODS
  Four biopsy specimens from the second portion of the duodenum: 2 by using the single-biopsy technique (1 bite per pass of the forceps) and an additional 2 by using the double-biopsy technique (2 bites per pass of the forceps). Specimens were blindly reviewed to determine orientation, consecutive crypt-to-villous units, and Marsh score.
  
  
  METHODS
  Proportion of well-oriented biopsy specimens.
  
  
  RESULTS
  Patients (N = 86) were enrolled, 47% with known celiac disease, 36% with suspected celiac disease, and 17% with an unknown celiac disease status. Well-oriented biopsy specimens were noted in 66% of patients with the single-biopsy technique and 42% of patients with the double-biopsy technique (P < .01). Analysis of matched pairs showed improved orientation with the single-biopsy technique (odds ratio 3.1; 95% confidence interval, 1.5-7.1; P < .01). This persisted in subgroup analysis of patients with known celiac disease (P = .02), villous atrophy (P = .02), and a final diagnosis of celiac disease (P < .01).
  
  
  CONCLUSIONS
  A single-center trial.
  
  
  CONCLUSIONS
  The single-biopsy technique improves the yield of well-oriented duodenal biopsy specimens. Endoscopists should consider taking only 1 biopsy specimen per pass of the forceps in patients undergoing biopsies of the duodenal mucosa.
authors: Celiac Disease Center, Department of Medicine, Columbia University, New York, New York, USA.
authors: Melissa
authors: M
authors: Latorre
authors: Celiac Disease Center, Department of Medicine, Columbia University, New York, New York, USA.
authors: Stephen M
authors: SM
authors: Lagana
authors: Celiac Disease Center, Department of Medicine, Columbia University, New York, New York, USA.
authors: Daniel E
authors: DE
authors: Freedberg
authors: Celiac Disease Center, Department of Medicine, Columbia University, New York, New York, USA.
authors: Suzanne K
authors: SK
authors: Lewis
authors: Celiac Disease Center, Department of Medicine, Columbia University, New York, New York, USA.
authors: Benjamin
authors: B
authors: Lebwohl
authors: Celiac Disease Center, Department of Medicine, Columbia University, New York, New York, USA.
authors: Govind
authors: G
authors: Bhagat
authors: Celiac Disease Center, Department of Medicine, Columbia University, New York, New York, USA.
authors: Peter H R
authors: PH
authors: Green
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods / Q000592:standards*; D002446:Celiac Disease / Q000473:pathology*; D004386:Duodenum / Q000473:pathology*; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index