Are tissue sampling guidelines from ESGE in colitis followed in clinical practice?

Aims Guidelines for tissue sampling have been published by The European Society of Gastrointestinal Endoscopy (ESGE) on colitis. They recommend in patients with clinical signs and endoscopic signs of colitis, performing segmental biopsies (at least two from each segment), which should be placed in different specimen containers (ileum, caecum, ascending, transverse, descending, and sigmoid colon, and rectum). The ESGE recommends pancolonic dye-based chromoendoscopy or virtual chromoendoscopy with targeted biopsies of any visible lesions during surveillance endoscopy in patients with inflammatory bowel disease. ESGE also recommends that, in patients with known ulcerative colitis and endoscopic signs of inflammation, at least two biopsies be obtained from the worst affected areas for the assessment of activity or the presence of cytomegalovirus [1]. We aimed to observe clinical practice and compare these to the ESGE guidance in patients attending endoscopy for colitis.

Methods A single centre, retrospective of patients with colitis attending endoscopy at a district general hospital was performed. 50 consecutive patients with new diagnosis of colitis, 50 consecutive patients with colitis for surveillance, and 20 consecutive patients with colitis for assessment of severity of activity were studied. Findings from clinical practice observed was scrutinised and compared to ESGE guidance. Data was obtained from the endoscopy reporting tool (unisoft) and from the electronic patient records

Results 32 of the 50 patients (64%) with endoscopic signs of colitis followed guidance on biopsy protocol as per ESGE. In this study, the caecal intubation rate was 94%, with terminal ileal intubation rate of 80%. In this group 25/50 (50%) the colitis activity was documented by way of either the Mayo score or Ulcerative colitis endoscopy index of severity. 29 of 50 patients (58%) with colitis having a surveillance colonoscopy followed the ESGE biopsy protocol. 4 of 50 patients (8%) had chromoendoscopy as part of their colonoscopic surveillance procedure. 17 of 20 patients (85%) biopsies assessed for activity of colitis had biopsies. 7 of 17 patients (41%) having a biopsy had a comment regarding CMV inclusion bodies on histology. The histology request form specifically asked for assessment of CMV inclusion bodies in 5 of 17 patients (29%).

Conclusions From this study of clinical practice of patients attending endoscopy for colitis, either in terms of new diagnosis, surveillance, or for colitis severity assessment with presence of CMV, the tissue sampling protocol of the ESGE is poorly implemented. We recommend improved dissemination of the guidelines within the endoscopy department to improve practice. Specifically asking for CMV inclusion bodies to histopathology on the request form may increase its assessment.

Publication History

Article published online:
27 March 2025

• References

• 1 Endoscopic tissue sampling– Part 2: Lower gastrointestinal tract. European Society of Gastrointestinal Endoscopy (ESGE) Guideline Endoscopy. 2021. 53. 1261-1273