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Low yield for non-targeted biopsies of the stomach and esophagus during elective esophagogastroduodenoscopy.

Low yield for non-targeted biopsies of the stomach and esophagus during elective esophagogastroduodenoscopy.
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Dougherty MK, Santoiemma PP, Weber AT, Metz DC, Yang YX,


Dougherty MK, Santoiemma PP, Weber AT, Metz DC, Yang YX, (click to view)

Dougherty MK, Santoiemma PP, Weber AT, Metz DC, Yang YX,

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Endoscopy international open 2017 12 065(12) E1268-E1277 doi 10.1055/s-0043-119791
Abstract
Background and study aims
 Biopsies of non-specific mucosal findings are often performed during esophagogastroduodenoscopy (EGD). We sought to determine the prevalence and clinical utility of non-targeted biopsies of the stomach and esophagus.

Patients and methods
 We conducted a retrospective review of 949 outpatient EGDs performed at a US tertiary referral center. Non-targeted biopsies of the stomach were defined as either "normal" or "mild" to "moderate" "erythema" or "inflammation" without other endoscopic features. Non-targeted biopsies of the esophagus and gastroesophageal junction (GEJ) were defined as endoscopically "normal" mucosa. The primary outcome was the proportion of non-targeted biopsies resulting in "definite management change." Secondary outcomes included histopathologic diagnoses of Helicobacter pylori, intestinal metaplasia and esophageal eosinophilia.

Results
 Of 949 EGDs, 332 (35.0 %, 95 % CI 31.9 - 38.1 %) had a non-targeted biopsy taken at any site. Erythema in the gastric body and antrum was biopsied at a rate of 83 - 86 %, while biopsies of "normal"-appearing mucosa occurred at rates from 3 % (GEJ) to 15 % (body and antrum). The percentage of non-targeted biopsies that led to definite management change ranged from 5 % in the GEJ and esophagus to 9 % in the antrum, but did not significantly differ by mucosal appearance. Multivariable regression analyses suggested associations of language and age > 50 with management change from non-targeted gastric biopsy.

Conclusions
 Non-targeted biopsies of the stomach and esophagus led to definite management change in a small proportion of patients. Further studies are needed to identify patient and/or endoscopic characteristics and techniques to improve the yield of this practice.

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