How many biopsies are taken during an endoscopy

A gastric tissue culture may be considered normal if it does not show certain bacteria. Stomach acids normally prevent too much bacteria from growing. Feldman M, Lee EL. Philadelphia, PA: Elsevier Saunders; chap Epithelial neoplasms of the stomach. Gastrointestinal and Liver Pathology. Philadelphia, PA: Elsevier Saunders; chap 4.

Vargo JJ. Preparation for and complications of GI endoscopy. Reviewed by: Linda J. If more than one site was biopsied during an EGD, overall cost would drop as some components of cost only needed to be included once in the calculation.

This was factored into the final calculation of cost to prevent overestimation. The cost of the endoscopic procedure was not factored into cost of taking biopsies. We determined the cost per positive finding on histology by using the yield of abnormal findings in order to determine the amount of normal biopsies required to get an abnormal finding and determining cost based on this amount.

The yield of abnormal histology on normal upper endoscopy was identified by sites biopsied or diagnosis and expressed as a percentage and cost per positive finding. These same variables were used when determining clinical predictors of abnormal histology for macroscopically normal EGDs.

Data was collected in excel spreadsheets. SAS 9. Of these EGDs, were macroscopically normal, were macroscopically abnormal, and were excluded from this study Figure 1. The EGDs excluded from the study were due to repeated procedures within the same year, nonduodenal small bowel biopsies, or insufficient clinical, procedural, or histologic information.

A multivariable logistic regression of the clinical predictors of macroscopically normal EGDs is listed in Table 2. Table 3 lists the yield for GI diagnosis identified through taking biopsies in an endoscopically normal upper GI tract and the additional cost incurred to make each diagnosis.

A multivariable logistic regression identifying the clinical predictors of abnormal biopsy on macroscopically normal EGDs can be seen in Table 4. PPI therapy did not provide protection against abnormal histology in the esophagus or stomach in normal endoscopy on multivariable analysis.

The yield of an abnormal pathologic diagnosis and cost per positive finding in cases of macroscopically normal EGDs based on the clinical indication can be seen in Table 5. This study evaluated the utility of taking biopsies in the upper GI tract during a macroscopically normal EGD to determine the incremental increase in yield and cost. The literature has been lacking in assessing this question when it comes to the upper GI tract.

With the need for economic constraints, cutting back on unnecessary costs in clinical practice has become essential [ 9 ]. Pathology departments are also already inundated with time constraints from their busy workload. Therefore, determining if biopsies are necessary when endoscopy is normal is important. This is consistent with prior studies identifying older age, the use of NSAIDS or anticoagulation, and alarm features as predictors of abnormal EGDs except that anemia was a predictor of normal EGD in this study [ 8 , 23 — 26 ].

Predictors of abnormal histology on normal upper endoscopy were dependent on the site of biopsy. Taha et al. Predictors of abnormal gastric biopsy included older age and anticoagulation use. Aging has been shown to lead to increased abnormalities on gastric biopsy [ 28 ]. Predictors of abnormal duodenal biopsy were older age while endoscopic indications of anemia and dyspepsia make it less likely to have abnormal histology. Dyspepsia is a nonspecific complaint more likely to yield a normal biopsy than not.

However, other studies have shown that anemia is more likely to yield an abnormal duodenal biopsy especially when celiac disease is suspected [ 29 ]. Iron deficiency anemia has been shown to be a clinical predictor of abnormal EGD and duodenal histology. Unfortunately, we did not have iron studies on all patients with anemia to statistically assess if the population with iron deficiency was more likely to have an abnormal EGD and duodenal biopsy in our study.

The prevalence of a GI cause of anemia in patients without iron deficiency anemia is significantly lower than patients with iron deficiency anemia [ 30 ]. However, patients without iron deficiency anemia may still require endoscopy if there is evidence of acute or subacute GI bleeding where there is insufficient time to deplete iron stores.

The cost associated per positive diagnosis was substantial in some cases costing thousands of dollars. The yield and cost appeared to improve in cases where there was a targeted indication. For example, patients with a clinical indication of dysphagia had an increased yield of eosinophilic esophagitis and patients with diarrhea had an increased yield of celiac disease.

While these costs are less than the cost to investigate patients with chest pain or screen for malignancy, the clinical significance of taking biopsies in a normal upper GI tract is much less meaningful than these other necessary investigations especially when there is not a targeted indication [ 31 — 34 ].

The costs presented in this study are lower than other studies assessing the economic impact of current endoscopic practice [ 21 , 35 ]. The cost was based on Ministry of Health billing codes in Ontario and institutional costs. This cost is not accurately representative of academic institutions where pathologists are salaried. This cost is also an underestimate, as some variables could not be reliably translated into the final cost.

While we do not support avoiding taking biopsies in all macroscopically normal upper GI tracts, we believe that a tailored indication that alters management is the best indication. This is consistent with the recently released American Gastroenterological Association AGA guidelines on taking biopsies from a normal upper GI tract for an indication of dyspepsia [ 36 ].

The AGA guidelines recommended against taking esophageal biopsies in this case but recommended taking gastric biopsies only if the H. Intraepithelial lymphocytosis in the duodenum is a nonspecific finding with a diverse differential diagnosis including early celiac disease [ 37 ].

This is consistent with prior studies assessing the yield of celiac disease in patients with only intraepithelial lymphocytosis [ 38 ]. Even in this case, the yield of patients with celiac disease would only increase by 0. Gastric intestinal metaplasia was found in a small proportion of patients with macroscopically normal EGDs.

While there is some evidence suggesting a small risk of further progression to dysplasia and cancer, further studies are required to determine appropriate surveillance intervals once gastric intestinal metaplasia is identified [ 40 ]. Limitations of this study include its retrospective nature, which can lead to bias, confounding, and an inability to retrieve some results. This study is also a single center experience. As a wide variety of endoscopists performed the EGDs, variations may exist in the interpretation of normal, which can lead to skewing the outcomes.

Several GI pathologists also participated in this study and can also alter the results by variations in interpretation of the histology. Further to this, the amount of biopsies taken at each site was variable and in patchy diseases taking less biopsies may lead to underdiagnosis. However, even with the limitations of this study, there are still important deductions that can be made.

In conclusion, predictors of normal upper endoscopy included younger age, female sex, and nonspecific GI procedure indications while predictors of abnormal histology varied with site. The yield of the biopsy in normal upper endoscopy varied with location. Yield and subsequent cost benefit improves with targeted indications. Practitioners need to be aware of the additional expense incurred by biopsies of normal upper GI tract and should tailor biopsies to appropriate situations that alter clinical practice, such as dysphagia for eosinophilic esophagitis, H.

Sign in. I would be happy to receive news and updates from Cancer Chat. Create new account. Leave this field blank. Already a member? Sign in now. Not a member yet? Register now. Search for discussions or people.

Welcome to the forum. Did they say anything about why they took the biopsy? How many did they take? Best Regards Taff. Im just going to try and not think about it, it could be nothing or it could be serious. You probably had to wait a lot longer to get an appointment though.

This means ill have only had to wait for a week and a half when i get my results. I must remind you that i'm not a doctor and I have no medical qualifications. Best wishes james. Show per page: Suspected Subungual melanoma. Quick turnaround on xray. Hard lump in my breast. Small lump in neck and armpit. Upper endoscopy is also used to treat conditions of the upper gastrointestinal tract. Your doctor can pass instruments through the endoscope to directly treat many abnormalities - this will cause you little or no discomfort.

For example, your doctor might stretch dilate a narrowed area, remove polyps usually benign growths or treat bleeding. An empty stomach allows for the best and safest examination, so you should have nothing to eat or drink, including water, for approximately six hours before the examination.

Your doctor will tell you when you should start fasting as the timing can vary. Tell your doctor in advance about any medications you take; you might need to adjust your usual dose for the examination. Discuss any allergies to medications as well as medical conditions, such as heart or lung disease. Most medications can be continued as usual, but some medications can interfere with the preparation or the examination.

Inform your doctor about medications you're taking, particularly aspirin products or antiplatelet agents, arthritis medications, anticoagulants blood thinners such as warfarin or heparin , clopidogrel, insulin or iron products.

Also, be sure to mention any allergies you have to medications. Your doctor might start by spraying your throat with a local anesthetic or by giving you a sedative to help you relax. You'll then lie on your side, and your doctor will pass the endoscope through your mouth and into the esophagus, stomach and duodenum.

The endoscope doesn't interfere with your breathing. Most patients consider the test only slightly uncomfortable, and many patients fall asleep during the procedure. You will be monitored until most of the effects of the medication have worn off.