Ofei Sylvia, Boyle Brendan, Ediger Tracy, Hill Ivor
Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH.
J Pediatr Gastroenterol Nutr. 2015 Oct;61(4):440-4. doi: 10.1097/MPG.0000000000000834.
Histologic changes in celiac disease (CD) may be patchy or confined to the bulb. Present guidelines recommend obtaining multiple biopsies from the bulb and distal duodenum when evaluating for CD. Adherence to these recommendations among adult gastroenterologists is low. There are no such data for pediatric gastroenterologists. This study compared endoscopic biopsy practices among pediatric gastroenterologists in histologically confirmed patients with CD to those without histologically confirmed CD.
Retrospective review of esophagogastroduodenoscopies (EGDs) during a 13-month period was performed. Children with histologically confirmed CD and a random sample of age-matched children without CD were identified. Endoscopy and histology reports were reviewed. The site and number of biopsy samples obtained was recorded. The groups were compared for number of biopsies.
A total of 98 children with CD were compared with 103 controls without CD. The number of biopsies obtained in the group with CD was higher than the group without CD (5.9 ± 1.6 vs 3.6 ± 1.2) (P < 0.0001). In children with CD, 80.5% had ≥5 biopsies compared with 11.7% in the group without CD (P < 0.0001). Only 10% of the children in the group with CD had bulb biopsies documented compared with none in the group without CD.
Pediatric gastroenterologists at our center generally obtain the recommended number of biopsies in children with histologically confirmed CD but seldom document biopsies from the bulb. In those without histologic evidence of CD, fewer biopsies are obtained with none documented from the bulb. Failure to take the recommended number of biopsies could result in some missed cases of CD.
乳糜泻（CD）的组织学改变可能是片状的或局限于十二指肠球部。目前的指南建议在评估CD时从十二指肠球部和十二指肠远端获取多个活检样本。成年胃肠病学家对这些建议的遵循率较低。儿科胃肠病学家方面尚无此类数据。本研究比较了经组织学确诊的CD患儿与未确诊的CD患儿中儿科胃肠病学家的内镜活检操作情况。
对13个月期间的食管胃十二指肠镜检查（EGD）进行回顾性分析。确定经组织学确诊的CD患儿以及年龄匹配的未患CD的随机样本患儿。对内镜检查和组织学报告进行回顾。记录获取活检样本的部位和数量。比较两组的活检数量。
共对98例CD患儿与103例未患CD的对照患儿进行了比较。CD组获取的活检数量高于未患CD组（5.9±1.6对3.6±1.2）（P<0.0001）。在CD患儿中，80.5%进行了≥5次活检，而未患CD组为11.7%（P<0.0001）。CD组中只有10%的患儿有十二指肠球部活检记录，未患CD组则无。
我们中心的儿科胃肠病学家通常会在经组织学确诊的CD患儿中获取建议数量活检样本，但很少记录十二指肠球部活检情况。在无CD组织学证据的患儿中，获取的活检样本较少，且无十二指肠球部活检记录。未按建议数量进行活检可能导致一些CD病例漏诊。
