127 Is It Time to Justify Random Duodenal Biopsies? a One-Year Cost and Diagnostic Yield Analysis

Abstract Aim To evaluate the clinical justification, diagnostic yield, and cost implications of random duodenal biopsies performed during OGD in patients presenting with anaemia and/or weight loss, and to assess adherence to recommended pre-endoscopy coeliac serology testing. Method A retrospective review was conducted at a single UK centre, including all patients who underwent OGD with random duodenal biopsies in 2024 for anaemia and/or weight loss. Patients with visible mucosal abnormalities or confirmed malignancy were excluded. Each biopsy was costed at £82. Data collected included number of biopsies, presence of pre-endoscopy tissue transglutaminase IgA (tTG-IgA) testing, and final histological outcomes. Results A total of 567 patients were included. The cohort was predominantly middle-aged (median age 56) and 57.2% female. The median number of biopsies per patient was five. 231 patients were referred with anaemia. 47.6% of whom had tTG-IgA performed and coeliac disease was diagnosed in only 8 patients (3.46%). Biopsies cost approximately £94,710. On the other hand, 164 patients were referred for weight loss. Among which, 55.5% had serology performed beforehand. Coeliac disease was identified in 5 patients (3.48%), with biopsy costs estimated around £67,240. No malignancies were identified. Random biopsies were frequently performed without prior serological screening, with low diagnostic yield and high cost. Conclusions Our study highlights a gap between current practice and national guidance. Routine use of coeliac serology prior to OGD may reduce unnecessary biopsies, improve diagnostic efficiency, and support more cost-effective care.