Document Detail


Diagnostic yield and economic implications of endoscopic colonic biopsies in patients with chronic diarrhoea.
MedLine Citation:
PMID:  21973327     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Aims:  Random colonic biopsies are recommended to exclude microscopic colitis in patients with chronic diarrhoea especially when mucosa is macroscopically normal at endoscopy. This study aimed to assess the clinical outcome and economic impact of such a policy in an unselected group of patients with macroscopically normal mucosa. Methods:  All new patients undergoing colonoscopy for investigation of chronic diarrhoea between April and December 2009 were included. Patients were divided into two groups: 'macroscopically normal mucosa' (MNM) and 'macroscopically inflamed mucosa' (MIM). Endoscopic findings were correlated with histology of random biopsies and hematological parameters. Symptom status and any treatment were established from follow-up. The breakdown and overall cost of random biopsies for each patient with a MNM was determined, and cost incurred per diagnosis of microscopic colitis was established. Results:  Altogether 137 (90.1%) out of 152 patients with chronic diarrhoea had MNM at colonoscopy. Overall incidence of microscopic colitis in the study was 1.3% (2/152), both patients belonged to MNM group. At follow-up, both these patients had spontaneous symptom resolution without any specific treatment. The policy of undertaking random biopsies in patients with MNM incurred an extra cost of £22,057 to diagnose two cases of microscopic colitis but did not alter medical treatment. Conclusions:  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.
Authors:
A Hotouras; P Collins; W Speake; G Tierney; J N Lund; M A Thaha
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-10-4
Journal Detail:
Title:  Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland     Volume:  -     ISSN:  1463-1318     ISO Abbreviation:  -     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-10-6     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100883611     Medline TA:  Colorectal Dis     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 The Association of Coloproctology of Great Britain and Ireland.
Affiliation:
Centre for Digestive Diseases, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK. Department of Colorectal Surgery, Royal Derby Hospital, Derby, UK Faculty of Medicine and Health Sciences, Royal Derby Hospital, Derby, UK.
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