Guidance for biopsy practice used in endoscopy departments in the Leeds area
| Biopsy? | YES | NO |
|---|---|---|
| Oesophagus | Diagnosis and surveillance of Barrett's (4 biopsies every 2 cm) | Normal oesophagus |
| Any focal lesion or ulceration When the clinical and endoscopic data suggest eosinophilic oesophagitis | Reflux oesophagitis unless ulceration | |
| Ultrashort segment Barrett's | ||
| Stomach | Any focal lesion | Normal stomach |
| Unusual appearance or high suspicion of dysplasia/malignancy (when suspecting malignancy take 8 biopsies from the lesion, avoiding the ulcer base) | Diffuse ‘gastritis’—use CLO test to determine Helicobacter pylori status | |
| Duodenum | Diagnose/exclude coeliac disease when clinically indicated (≥3 biopsies in 1 cassette) | ‘Duodenitis’ at endoscopy |
| Colorectal | Normal colonoscopy in patients with persistent watery diarrhoea (send 2 cassettes—3 biopsies from right side and 3 from left side) | Other normal colonoscopy |
| Any polyp/other focal lesion | Ileal biopsy to demonstrate that the ileum has been reached | |
| Patient with known or genuinely suspected IBD | Random rectal biopsy for rectal bleeding. |