Which procedure is used to obtain the diagnostic duodenal biopsy in suspected celiac disease?

Which procedure is used to obtain the diagnostic duodenal biopsy in suspected celiac disease?

• A. Esophagogastroduodenoscopy with duodenal biopsy
• B. Colonoscopy
• C. Capsule endoscopy
• D. MR enterography

Answer: (A)

Obtaining a diagnosis of celiac disease relies on tissue from the small intestine, most often the duodenum. The only way to both visualize the duodenal mucosa and obtain multiple biopsy samples is through an upper endoscopy, specifically an esophagogastroduodenoscopy with duodenal biopsy. This allows pathologists to look for the characteristic histologic changes—villous atrophy with crypt hyperplasia and increased intraepithelial lymphocytes—that confirm the diagnosis in the appropriate clinical and serologic context. The other options don’t provide tissue samples from the duodenum: colonoscopy targets the colon, capsule endoscopy can visualize but not biopsy the small bowel, and MR enterography is imaging without tissue sampling. Hence, endoscopy with biopsy is the correct approach.

Obtaining a diagnosis of celiac disease relies on tissue from the small intestine, most often the duodenum. The only way to both visualize the duodenal mucosa and obtain multiple biopsy samples is through an upper endoscopy, specifically an esophagogastroduodenoscopy with duodenal biopsy. This allows pathologists to look for the characteristic histologic changes—villous atrophy with crypt hyperplasia and increased intraepithelial lymphocytes—that confirm the diagnosis in the appropriate clinical and serologic context.

The other options don’t provide tissue samples from the duodenum: colonoscopy targets the colon, capsule endoscopy can visualize but not biopsy the small bowel, and MR enterography is imaging without tissue sampling. Hence, endoscopy with biopsy is the correct approach.