Diagnostic yield and economic implications of endoscopic colonic biopsies in patients with chronic diarrhoea

Abstract

In unselected patients with chronic diarrhoea and macroscopically normal mucosa, random colonic biopsies have a low diagnostic yield and incur a high cost. Continued research for predictive markers to improve patient selection for targeted biopsies is needed to develop a cost-effective investigative algorithm in chronic diarrhoea.

Microscopic Colitis and Colorectal Neoplastic Lesion Rate in Chronic Nonbloody Diarrhea

“…In one large retrospective survey from Sweden (1018 subjects), MC was identified in 10% of patients and in almost 20% of those older than 70 years. 3,29 Compared with the current literature, our results present 2 main additional peculiarities. 18 By contrast, 2 large endoscopic cohorts reported much lower diagnostic yields (1.1%-1.3%), raising questions about the cost-effectiveness of random biopsies in unselected subjects with CNBD.…”

“…Although the growing physicians' awareness would have revealed the hidden part of the "iceberg" with a widespread use of random colonic biopsies, 5,7,10,11 a greater exposition to disease-related factors such as drugs consumption [12][13][14] or smoking habit [15][16][17] could have led to a further spread of the disease. 3,29 Indeed, our knowledge about MC epidemiology is still limited and affected by controversial evidences. Nonetheless, the literature depicts large differences among different countries, varying between 1 and 9 female cases for each male case.…”

Expert opinions and scientific evidence for colonoscopy key performance indicators

“…Other data exist suggesting that changes in the large bowel mucosa may be patchy, and as such, left-sided and right-sided colonic biopsies should be taken for diagnosis 318–321. However, the cost-effectiveness of this policy has been questioned 322. Local policies on biopsy for unexplained diarrhoea should be developed.…”

Fluorescence lifetime spectroscopy of tissue autofluorescence in normal and diseased colon measured ex vivo using a fiber-optic probe

“…Therefore all polyps are removed when detected unless there is a clinical reason to delay the endoscopic resection and, following the current clinical best practice in GI endoscopy for tissue abnormalities, are biopsied or excised and sent for histological assessment and interpretation. This leads to unnecessary removal of benign lesions and a considerable number of tissue biopsies, which are a significant burden on the healthcare system [5] and can be coupled with a low diagnostic yield [6,7]. A non-invasive method of diagnosis could remove the need for physical biopsy and provide improvements in diagnostic accuracy for a number of diseases.…”