In the past, small-bowel biopsies for diagnosis of celiac disease were taken from the jejunum with a suction capsule, but nowadays most physicians take endoscopic biopsies from the distal duodenum.
In order to validate this practice, Dr J Kolkman and colleagues from the Netherlands compared the diagnostic yield of endoscopic duodenal biopsies with that of endoscopic jejunal biopsies.
In addition, the researchers describe a method of orienting biopsy specimens optimally.
Upper endoscopy was performed with a colonoscope.
|3 patients had normal duodenal biopsies while jejunal biopsies showed Marsh I-II lesions |
4 jejunal and 4 duodenal biopsies were taken and oriented immediately thereafter.
The pathologist rated the orientation as poor, adequate, or good, and then expressed the histopathological results according to the Marsh classification.
The researchers then compared the jejunal and duodenal biopsy results.
In total, the research team included 146 patients.
Jejunal biopsies were taken in 142 patients, and the pathologist found Marsh I-II lesions in 56 and Marsh III lesions in 15 patients.
The researchers found that 3 patients had normal duodenal biopsies while jejunal biopsies showed Marsh I-II lesions.
However, the team found no discrepancies in patients with Marsh III lesions.
Orientation was good in all biopsies.
Dr Kolkman concluded, "Duodenal biopsies are sufficient to diagnose full-blown celiac disease (Marsh III), but Marsh I-II lesions may be missed in some cases."