Impact Of Taking Biopsies In Macroscopically Normal Endoscopies On The Nhs - Is There Inter-Operator Variability And Need For Stringent Guidelines And Training?

Aims Numerous studies have questioned the value of taking biopsies in macroscopically-normal mucosa. Inappropriate biopsies increase financial and time pressures on the increasingly-strained endoscopy, pathology and NHS services. We hypothesized that non-physician endoscopists have greater uptake on performing biopsies in macroscopically normal endoscopies.

Methods We did a retrospective study of diagnostic gastroscopies and colonoscopies performed across 3 district-general hospitals (January-November 2018) in United Lincolnshire Hospitals NHS Trust. Endoscopic reports were examined for age, sex, indication, endoscopic diagnosis, biopsies taken (yes/no), and operator (gastroenterologist/surgeon/nurse endoscopist {NE}). We classified ‘biopsy not indicated’ when mucosa was described as ‘normal’ for indications of anaemia, rectal bleeding, weight-loss in colonoscopies, and dyspepsia, vomiting and abdominal pain in gastroscopies.

Results A total of 326 gastroscopies and 355 colonoscopies were included. 170 procedures fulfilled the ‘biopsy not indicated’ classification, of which 59 % had multiple biopsies taken. Biopsy rates among gastroenterologists, surgeons, and NEs in ‘biopsy not indicated’ were 53 % (39/73), 60 % (42/70) and 70 % (19/27) respectively. Using Chi-square, there was no statistically significant difference between various groups: surgeons and NEs (p= 0.34), surgeons and gastroenterologists (p= 0.42), and gastroenterologists and NEs (p= 0.12). This rejects our hypothesis.

Conclusions Our study showed that a significant number of biopsies are performed without good indication, with no significant inter-operator variability. Both British Society of Gastroenterology and National Institute for Health and Care Excellence have published guidance on when biopsy is indicated, but there are few high-level recommendations on when not to biopsy. Findings from our study mandate development of such guidance, followed by training of all endoscopists and UK-wide audit of local practice to ensure compliance with guidelines. The implementation of such strategies has been proven effective at a local level, and if adopted nationally can significantly optimise financial burden of endoscopy services on the NHS.

Citation Cianci N, Varghese B, Sreedharan A et al. eP116 IMPACT OF TAKING BIOPSIES IN MACROSCOPICALLY NORMAL ENDOSCOPIES ON THE NHS - IS THERE INTER-OPERATOR VARIABILITY AND NEED FOR STRINGENT GUIDELINES AND TRAINING?. Endoscopy 2021; 53: S134.

Publication History

Article published online:
19 March 2021