CC BY-NC-ND 4.0 · Endosc Int Open 2017; 05(12): E1220-E1228
DOI: 10.1055/s-0043-120522
Original article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2017

Factors associated with number of duodenal samples obtained in suspected celiac disease

Leonid Shamban1, Serge Sorser2, Stan Naydin3, Benjamin Lebwohl4, Mousa Shukr5, Charlotte Wiemann5, Daniel Yevsyukov6, Michael H. Piper7, Bradley Warren7, Peter H. R. Green8
  • 1Gastroenterology, Genesys Regional Medical Center, Grand Blanc, Michigan, United States
  • 2Gastroenterology, Providence-Providence Park Hospital, Novi, Michigan, United States
  • 3Internal Medicine, Drexel University, Philadelphia, Pennsylvania, United States
  • 4Clinical Medicine, Columbia University, New York, New York, United States
  • 5Internal Medicine, Providence-Providence Park Hospital, Southfield, Michigan, United States
  • 6Division of Solid Organ Transplant, University of Minnesota Medical School Twin Cities, Minneapolis, Minnesota, United States
  • 7Gastroenterology, Providence-Providence Park, Southfield, Michigan, United States
  • 8Clinical Medicine, Columbia University, New York, New York, United States
Further Information

Publication History

submitted 30 December 2016

accepted after revision 26 June 2017

Publication Date:
06 December 2017 (online)


Background and study aims Many people with celiac disease are undiagnosed and there is evidence that insufficient duodenal samples may contribute to underdiagnosis. The aims of this study were to investigate whether more samples leads to a greater likelihood of a diagnosis of celiac disease and to elucidate factors that influence the number of samples collected.

Patients and methods We identified patients from two community hospitals who were undergoing duodenal biopsy for indications (as identified by International Classification of Diseases code) compatible with possible celiac disease. Three cohorts were evaluated: no celiac disease (NCD, normal villi), celiac disease (villous atrophy, Marsh score 3), and possible celiac disease (PCD, Marsh score < 3). Endoscopic features, indication, setting, trainee presence, and patient demographic details were evaluated for their role in sample collection.

Results 5997 patients met the inclusion criteria. Patients with a final diagnosis of celiac disease had a median of 4 specimens collected. The percentage of patients diagnosed with celiac disease with one sample was 0.3 % compared with 12.8 % of those with six samples (P = 0.001). Patient factors that positively correlated with the number of samples collected were endoscopic features, demographic details, and indication (P = 0.001). Endoscopist factors that positively correlated with the number of samples collected were absence of a trainee, pediatric gastroenterologist, and outpatient setting (P < 0.001).

Conclusions Histological diagnosis of celiac disease significantly increased with six samples. Multiple factors influenced whether adequate biopsies were taken. Adherence to guidelines may increase the diagnosis rate of celiac disease.