Document resource
Introduction Demand for endoscopy is increasing with London experiencing a 26% rise in activity over the last four years. Over 1.5 million endoscopic procedures are performed annually in the UK, with approximately 45% resulting in biopsies. Histopathology services are under increasing pressure, with departments failing to meet a 70% 10-day turnaround target. There is renewed focus on appropriate biopsy practice, with NHS England London and BSG publishing guidance. We evaluated real world adherence to these recommendations during routine endoscopy at a large UK tertiary centre to inform a South East London network quality improvement initiative.Methods 500 endoscopic procedures were retrospectively assessed against biopsy guidance recommendations. Data collected included procedure type, indication, endoscopist grade, number of biopsies taken and guideline concordance. Excess biopsies were defined as those taken without a guideline supported indication. Descriptive statistics were used, and free-text endoscopy reports were reviewed.Results 500 procedures were reviewed; 200 colonoscopy, 51 flexible sigmoidoscopy and 249 OGD. Biopsies were indicated in 163/500 (32.6%) procedures and were taken in 159/163 (97.5%), sampling was concordant in 103/159 (64.8%). Within indicated biopsies, 14/159 (8.8%) involved under-sampling (mean −2 per procedure), while 39/159 (24.5%) involved over-sampling (mean +3.9 per procedure).Biopsies were not indicated in 337/500 (67.4%) but were taken in 64/337 (19.0%) with excess biopsies (mean +3.8). Overall, 117/500 (23.4%) procedures had non-concordant sampling, most commonly during OGD. This varied by staff group; 32/88 (36%) by agency endoscopists, 46/138 (33%) by SpR, 25/107 (23%) by nurse endoscopists and 19/167 (11%) by consultants (χ2(3) = 28.21, p < 0.0001).Non-indicated biopsies were commonly for gastritis and fundic gland polyps; under-sampling was most frequent in suspected coeliac disease, and over-sampling in suspected microscopic colitis.Conclusions In this large service evaluation, biopsy practice was largely compliant, though 23.4% showed non-concordant sampling. As it has been estimated that biopsies add approximately £60 to a procedure, cost savings in this case series could hypothetically equate to savings of approximately £39,000 per year. These findings highlight clear opportunities to rationalise biopsy practice in line with BSG and NHS England guidance, with potential benefits for diagnostic quality, histopathology workload, healthcare cost and environmental sustainability. This work will inform a South East London network quality improvement initiative aimed at standardising indication-based biopsy practice across services.Abstract P282 Table 1Concordance of biopsy practiceGuideline-concordantUnder-samplingOver-samplingBiopsies indicated (n=163)1031439Biopsies not indicated(n=337)273-64All procedures(n=500)37614103