Endoscopic duodenal biopsy in children.

Background: Biopsy of the small bowel is frequently obtained by endoscopic forceps instead of the classical suction capsule, yet reports from developing countries are scarce.

Aim Of The Study: to report our experience on the diagnostic value of this procedure in our community.

Patients And Methods: A retrospective analysis of all endoscopic duodenal biopsies (EDB), performed on all patients below 18 years of age. Data retrieved from the records included age, gender, nationality, indication for biopsy, the endoscopic findings, and the results of histopathology.

Results: From 1993 to 2002, 241 endoscopic biopsies were performed on 241 consecutive children. Most of the children (96%) were Saudi nationals, the age range between six weeks to 18 years, and male to female ratio was 0.7:1. All of the biopsy material was adequate for routine histopathology. The commonest indications for biopsy were short stature and chronic diarrhea in 116/241 (48%) and 102/241 (43%) of the children respectively. Refractory rickets accounted for 11/241 (5%) of the indications. The prevalence of villous atrophy was highest in children presenting with chronic diarrhea (40%), compared to short stature (22%). Other less common, but important findings were villous atrophy in three unusual conditions (one refractory rickets, one unexplained anemia, and one polyendocrinopathy), two cases of intestinal Giardia lamblia infestation, three cases of intestinal lymphangiectasis and one case of Mycobacterium avium intracellulare. Unexpected endoscopic findings were documented in 34/241 (14%) of the children.

Conclusions: Endoscopic duodenal biopsy is adequate not only for the diagnosis of villous atrophy, but also for the detection of other gastroenteropathies. Accordingly, when expertise and equipment are available, EDB should be the procedure of choice not only in industrialized but also in developing countries.