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CC BY-NC-ND 4.0 · Endosc Int Open 2017; 05(12): E1268-E1277
DOI: 10.1055/s-0043-119791
Original article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2017

Low yield for non-targeted biopsies of the stomach and esophagus during elective esophagogastroduodenoscopy

Michael K. Dougherty
1   Division of Gastroenterology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
,
Phillip P. Santoiemma
2   Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
,
Andrew T. Weber
3   Department of Medicine, University of California Los Angeles, Los Angeles, California, United States
,
David C. Metz
4   Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Yu-Xiao Yang
5   Division of Gastroenterology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
› Author Affiliations
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Publication History

submitted 21 November 2016

accepted after revision 31 July 2017

Publication Date:
06 December 2017 (online)

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Abstract

Background and study aims Biopsies of non-specific mucosal findings are often performed during esophagogastroduodenoscopy (EGD). We sought to determine the prevalence and clinical utility of non-targeted biopsies of the stomach and esophagus.

Patients and methods We conducted a retrospective review of 949 outpatient EGDs performed at a US tertiary referral center. Non-targeted biopsies of the stomach were defined as either “normal” or “mild” to “moderate” “erythema” or “inflammation” without other endoscopic features. Non-targeted biopsies of the esophagus and gastroesophageal junction (GEJ) were defined as endoscopically “normal” mucosa. The primary outcome was the proportion of non-targeted biopsies resulting in “definite management change.” Secondary outcomes included histopathologic diagnoses of Helicobacter pylori, intestinal metaplasia and esophageal eosinophilia.

Results Of 949 EGDs, 332 (35.0 %, 95 % CI 31.9 – 38.1 %) had a non-targeted biopsy taken at any site. Erythema in the gastric body and antrum was biopsied at a rate of 83 – 86 %, while biopsies of “normal”-appearing mucosa occurred at rates from 3 % (GEJ) to 15 % (body and antrum). The percentage of non-targeted biopsies that led to definite management change ranged from 5 % in the GEJ and esophagus to 9 % in the antrum, but did not significantly differ by mucosal appearance. Multivariable regression analyses suggested associations of language and age > 50 with management change from non-targeted gastric biopsy.

Conclusions Non-targeted biopsies of the stomach and esophagus led to definite management change in a small proportion of patients. Further studies are needed to identify patient and/or endoscopic characteristics and techniques to improve the yield of this practice.

 

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