An actual GI biopsy question...

[cmz]

---

Members don't see this ad.

There is this one group of GI that do A LOT of biopsies, especially gastric biopsies. I am not a GI-fellowship trained pathologist, but I do read stuff and try to keep abreast of current guidelines, etc. This group tends to ALWAYS do at least four gastric biopsies (body, fundus, antrum, and incisura) on every single patient. I have read their endoscopic notes and there is always a vague mention of "mild diffuse gastritis" no matter what.

In normal practice, I usually got these types of biopsies (in most cases) when the patient was suspected of having an autoimmune process or maybe for mapping IM. If the question is simply to look for HP, why can't this question be asked with maybe two sets of biopsies? I have my deep suspicion as to why it is being done, but I am trying to see if there is actually any reason why it would be important to know if a patchy process like HP infection needs to be teased out by assigning each biopsy as such. I guess they are taking the Sydney guidelines to the Nth degree? It just seems overkill...

 

[Pathofourlives]

I’ve worked for a GI private practice and heard a lot about others as I’m GI trained. Many of these practices pad the bill with unnecessary biopsies. My previous practice even asked me if it was a potential red flag to payors that they took 10-12 biopsies (including uppers and lowers) per patient. I presume because they were getting kicked back claims. Does this practice also do the shady AB/PAS on every esophagus and duodenum?

 

[cmz]

I don't think they do erroneous AB/PAS on every esophagus/duodenum, but I don't work for them or see biopsies that go to their lab. I just catch the stray biopsies they have to perform at the hospital ASC just because of the patient population requiring a higher level of acuity just in case.

I just find it a bit concerning regarding the number of samples being taken. If I don't see bugs on H&E and I see more than the usual amount of inflammation, I feel obligated to do HP IHC. I could have probably evaluated all of these biopsies in two blocks (or hell even one block) because the endoscopist is only giving me a rinky dink single biopsy per jar to begin with and I would have felt better just ordering 1 HP stain at this point. I just want to make sure my own butt is protected (I do a lot of documentation of necessity in my reports as it is).