A questionnaire study assessing overuse injuries in United Kingdom endoscopists and any effect from the introduction of the National Bowel Cancer Screening Program on these injuries (original) (raw)

2011, Gastrointestinal Endoscopy

We read with great interest the study by Gonzalez et al, 1 in which the role and the diagnostic value of duodenal bulb biopsies in the management and diagnosis of celiac disease were investigated. The authors conclude that the diagnostic yield, because of the patchy damage of the celiac disease enteropathy, is increased by performing duodenal bulb biopsies. The study investigates an interesting topic, but we think that some methodological points need to be clarified. First, it is unusual that in a tertiary referral hospital, only 319 of 1079 biopsy samples (30%) were well oriented, and consequently there was an unacceptable loss of approximately 37% of the patients. Orientation of the duodenal specimens is a determinant for a correct diagnosis, and well-known techniques to obtain adequate samples are available in the literature. 2,3 Second, from their Tables 4 and 5, it appears that 50% of the samples from duodenal bulb were inadequate and only 1 patient had 4 adequate biopsy samples from the distal duodenum, as required by international standards 4 ; thus, it is very difficult to derive conclusions about the concordance of bulb and D2 lesions and, moreover, to define true negative subjects. In conclusion, these results should be interpreted with caution and, by our own experience, the main message is that in a center devoted to celiac disease diagnosis and management, strict collaboration among gastroenterologists, endoscopists, and pathologists is essential.