Sa1449 Diagnostic Yield of Colonoscopy With Random Colonic Biopsies in the Evaluation of Chronic Diarrhea

Sa1449 Diagnostic Yield of Colonoscopy With Random Colonic Biopsies in the Evaluation of Chronic Diarrhea Laura Pestana*, Michael Camilleri, Sunanda V. Kane Department of Medicine, Mayo Clinic, Rochester, MN Background: In the evaluation of patients with chronic diarrhea, colonoscopy with random colonic biopsies is recommended for those individuals in whom initial laboratory studies fail to generate a diagnosis. However, in outpatient open access endoscopy practice, demand for colonoscopy may exceed availability. Several reports have documented that chronic unexplained diarrhea without rectal bleeding (or functional diarrhea) may be due to celiac disease (w4%), bile acid malabsorption (25-40%) or disaccharidase deficiency. These conditions are typically not identified by colonoscopy or biopsies. In an effort to identify possible inappropriate use of colonoscopy and optimize access to the procedure for other indications, we evaluated the diagnostic yield of colonoscopy with random biopsy for patients with chronic diarrhea in an open access endoscopy practice at a tertiary care center. Methods: We searched the electronic medical records and endoscopic database for outpatients undergoing colonoscopy with biopsy procurement for the indication “diarrhea” or “change in bowel habit” over 18 months October 1, 2012 to May 23, 2014. Clinical data included gender, specialty of the referring physician, documentation of potential alarm symptoms (anemia, weight loss or bleeding) and results of colonic mucosal biopsies. Results: Five hundred forty three patients were identified. Sixty nine percent were female. Two-thirds of patients (63.2%) were referred by a gastroenterologist. Anemia was present in 83 patients (15.3%); presence of weight loss was inconsistently documented. Histologic abnormalities were noted in 130 patients (23.9%); microscopic colitis or other abnormalities leading to change in management occurred in only 100 (18%) patients. The majority of in the latter patients had been referred by a gastroenterologist. Conclusion: Colonoscopy with random colonic biopsies for the evaluation of chronic diarrhea failed to yield a histologic diagnosis for the majority of patients in a tertiary care open access endoscopy practice. These data suggest the need for enhancing the work up of diarrhea prior to ordering colonoscopy in an open access system to enhance care, and reduce the number of inappropriate procedures thereby improving access for truly indicated procedures.