Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals, Headington, Oxford, UK.
NIHR Oxford Biomedical Research Centre, Oxford, UK.
Dig Dis. 2021;39(3):179-189. doi: 10.1159/000511867. Epub 2020 Oct 1.
Guidelines give robust recommendations on which biopsies should be taken when there is endoscopic suggestion of gastric inflammation. Adherence to these guidelines often seems arbitrary. This study aimed to give an overview on current practice in tertiary referral centres across Europe.
Data were collected at 10 tertiary referral centres. Demographic data, the indication for each procedure, endoscopic findings, and the number and sampling site of biopsies were recorded. Findings were compared between centres, and factors influencing the decision to take biopsies were explored.
Biopsies were taken in 56.6% of 9,425 procedures, with significant variation between centres (p < 0.001). Gastric biopsies were taken in 43.8% of all procedures. Sampling location varied with the procedure indication (p < 0.001) without consistent pattern across the centres. Fewer biopsies were taken in centres which routinely applied the updated Sydney classification for gastritis assessment (46.0%), compared to centres where this was done only upon request (75.3%, p < 0.001). This was the same for centres stratifying patients according to the OLGA system (51.8 vs. 73.0%, p < 0.001). More biopsies were taken in centres following the MAPS guidelines on stomach surveillance (68.1 vs. 37.1%, p < 0.001). Biopsy sampling was more likely in younger patients in 8 centres (p < 0.05), but this was not true for the whole cohort (p = 0.537). The percentage of procedures with biopsies correlated directly with additional costs charged in case of biopsies (r = 0.709, p = 0.022).
Adherence to guideline recommendations for biopsy sampling at gastroscopy was inconsistent across the participating centres. Our data suggest that centre-specific policies are applied instead.
当内镜提示胃有炎症时，指南给出了关于应进行哪些活检的有力建议。但这些指南的执行往往显得随意。本研究旨在概述欧洲三级转诊中心的当前实践情况。
在 10 家三级转诊中心收集数据。记录人口统计学数据、每例检查的适应证、内镜发现、活检的数量和采样部位。比较各中心之间的结果，并探讨影响活检决策的因素。
在 9425 例检查中，有 56.6%进行了活检，各中心之间存在显著差异（p < 0.001）。所有检查中，胃活检占 43.8%。采样部位因适应证而异（p < 0.001），但各中心之间没有一致的模式。在常规应用更新后的悉尼胃炎评估分类（46.0%）的中心，活检数量较少，而仅在有要求时才应用的中心（75.3%，p < 0.001），这种情况也适用于根据 OLGA 系统对患者进行分层的中心（51.8% vs. 73.0%，p < 0.001）。遵循 MAPS 胃监测指南的中心活检数量更多（68.1% vs. 37.1%，p < 0.001）。在 8 个中心中，活检的可能性随患者年龄的增长而增加（p < 0.05），但在整个队列中并非如此（p = 0.537）。有活检的检查例数与活检时收取的额外费用直接相关（r = 0.709，p = 0.022）。
参与中心在胃内窥镜活检采样时对指南建议的依从性不一致。我们的数据表明，各中心采用了特定的政策。
