Scarsa efficacia di biopsie random in esofago e stomaco

Low yield for non-targeted biopsies of the stomach and esophagus during elective esophagogastroduodenoscopy.Dougherty MK, Santoiemma PP, Weber AT, Metz DC, Yang YX. Endosc Int Open. 2017 Dec;5(12):E1268-E1277.

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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