Objective: To determine whether development of localised protocol could reduce the number of non-targeted gastric biopsies taken at endoscopy, without risking harm from non-detection of malignant conditions.
Design: Retrospective analysis of patient records over a 3-month period in 2013, repeated in 2015 following intervention.
Setting: Two UK teaching hospitals.
Patients: Patient record data on indication for endoscopy, endoscopy findings, histopathology results and patient outcome.
Interventions: Guidance on upper gastrointestinal biopsy in the form of a new trust-wide protocol, as well as lecture-based education.
Main outcome measures: Rates of non-targeted and targeted biopsies before and after intervention, and differences between grade of endoscopist.
Results: Between 2013 and 2015, there was a 36% reduction in non-targeted biopsies (10.4% vs 6.7%, p=0.001), predominantly within registrar and nurse endoscopist groups, with reduction in non-targeted biopsies of 9.5% and 64%, respectively. Percentage of targeted biopsies remained relatively static, 7.9% and 8.2%. In 2013, 92% of non-targeted biopsies had no management change based on histology; in 2015 this was 90%. Of patients with alteration to management, only 0.4% and 0.7% were due to malignancy, in known high-risk patients. Reduction in non-targeted biopsies resulted in estimated annual savings in this trust of £36,000.
Conclusion: Development of local protocol reduces the numbers of non-targeted biopsies taken, without risk of harm from non-detection of malignant conditions, enabling a significant reduction in workload within busy histopathology services, with significant cost savings. Localised protocols are adaptable to local population demographics.
Keywords: cost-effectiveness; endoscopy; histopathology.