Document resource
Introduction Urgent suspected cancer iron deficiency anaemia (USCIDA) is a common indication for gastroscopy. The British Society of Gastroenterology (BSG) guidelines recommend Coeliac serology (tTGIgA) prior to referral and advise against routine duodenal (D2) biopsies in IDA with negative tTGIgA, unless there is high clinical suspicion. We investigated adherence to BSG guidance regarding Coeliac serology testing and low value D2 biopsies in tTGIgA negative patients in a single centre audit, including a cost analysis.Methods Data was extracted via SLQ query from the backend from the electronic health record. A retrospective analysis of 561 gastroscopies on the USCIDA pathway was conducted evaluating pre-endoscopy tTGIgA results and D2 biopsies in tTGIgA negative patients.Data on demographics and investigations (tTGIgA, gastroscopy (OGD) and histology) were analysed. Primary outcomes were the proportion of pre-referral tTGIgA blood results and OGDs with D2 biopsy despite negative tTGIgA serology. Histology from all D2 biopsies in tTGIgA negative patients was reviewed. A minimum cost analysis was performed using £133.33 per D2 biopsy histology. Statistical analysis was performed with GraphPad Prism.Results The USCIDA cohort had a mean age of 69.7 (SD 13.3), 55.8% were female. 78% were white, 5.9% from a non-white ethnic background, with no data for the remaining 16.1%. Of the 561 patients who underwent OGD, a tTGIgA blood result was available in only 46.7% (262 patients), of which 98.5% had a negative tTGIgA result, and only 1.5% returning possible Coeliac disease. D2 biopsies were still taken in 30% (n=78) of the negative tTGIgA cases. Duodenal histology was normal in all 78 biopsies. Processing a single set of D2 biopsies costs £133, amounting to a total cost of £10,374. See table 1.Conclusion Despite BSG recommendations to obtain tTGIgA serology prior to referral on the USCIDA pathway, over half of the patients (53.3%) had no result available at the time of endoscopy. Low value D2 biopsies were still taken in 30% of patients despite negative tTGIgA, with 0% diagnostic yield in this study. Low value D2 biopsies come at a considerable cost at £133 each, amounting to £10,374 in this limited series alone. Further education and IT based reporting prompts requiring justification for biopsies may help to reduce low value biopsies not only in Coeliac disease, but across endoscopy.Abstract P272 Table 1Total gastroscopies for IDA (2024, adjusted)561 tTGIgA recorded262 / 561 (46.7%) tTGIgA not recorded299 / 561 (53.3%) tTGIgA negative (≤10) among tested258 / 262 (98.5%) Manually validated tTGIgA negative gastroscopies258 D2 biopsies in tTGIgA negative patients78 / 258 (30.2%) Coeliac disease on D2 biopsy0 / 78 (0%) Cost per D2 biopsy£133.33Histology cost total£10,399.74