Duodenal biopsies for coeliac disease: Does size matter?

Aims Most adult patients require endoscopy and duodenal biopsies to diagnose coeliac disease. However, individuals who are unwilling or unable to undergo conventional endoscopy are left without diagnostic options or a formal diagnosis. We aimed to determine whether the small-sized biopsy forceps used during transnasal endoscopy (TNE) can provide adequate duodenal biopsy specimens for diagnosing coeliac disease.

Methods We prospectively recruited adult patients (≥ 18 years) with suspected coeliac disease between May and July 2024. All patients underwent peroral endoscopy, with four biopsies taken from the second part of the duodenum (D2) and one from the duodenal bulb (D1) using standard 2.8mm biopsy forceps. The biopsy protocol was then repeated using a smaller 2mm biopsy forceps. Expert pathologists evaluated all samples for size, quality, and Marsh classification.

Results Ten patients (median age 45 years, 50% female) were included in the study, of whom 7 (70%) were diagnosed with coeliac disease. In total, 100 duodenal biopsy specimens were collected and analysed (50 using the standard biopsy forceps and 50 using the smaller biopsy forceps). The size of D2 biopsies was significantly larger when using the standard biopsy forceps compared with the smaller forceps (4.5mm vs 3mm, p=0.001). Similarly, biopsies from D1 were also larger with the standard forceps (3mm vs 2mm, p=0.002). The smaller forceps provided sufficient material for accurate classification in all cases, and the agreement between biopsies obtained using both forceps in D2 and D1 was 100% (k=1.0)

Conclusions This pilot study demonstrates that small-sized biopsy forceps, used during TNE, can provide adequate tissue for histopathological diagnosis in patients with suspected coeliac disease. These findings pave the way for considering TNE as a more tolerable alternative to conventional endoscopy in diagnosing coeliac disease.

 

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Conflicts of Interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
27 March 2025