D0634 - Prevalence and Predictors of Follow-Up Endoscopic Biopsy in Patients With Celiac Disease in the United States

Manu V. Venkat, MD, Ling Chen, BSc, Jason D. Wright, MD, Benjamin Lebwohl, MD, MS
Columbia University Medical Center, New York, NY

Introduction: Though endoscopy with small intestinal biopsy is usually required to confirm the diagnosis of celiac disease, the role of follow-up biopsy is less certain. It can be considered if symptoms persist, or for surveillance since persistent villous atrophy may predict disease outcomes. Guidelines do not specifically recommend for or against follow-up biopsy in asymptomatic patients, and the practice patterns regarding follow-up biopsy in the U.S. are poorly understood. We aimed to characterize the frequency and predictors of a second intestinal biopsy in patients with biopsy-diagnosed celiac disease.

Methods: Using the IBM MarketScan Commercial Claims and Encounters database and Medicare Supplemental and Coordination of Benefits database, we identified patients with a diagnosis code for celiac disease and at least one claim for an endoscopic biopsy from 2009-2019. Patients were followed for at least six months after the 1^st biopsy until they received a 2^nd endoscopic biopsy or continuous insurance coverage ended. Predictors of 2^nd endoscopic biopsy were assessed using a Cox proportional hazards model.

Results: A total of 30,737 patients were identified. Among them, with a median follow-up time of 22.8 months, 5,976 (19.4%) had a follow-up biopsy. The median time between the initial and follow-up biopsies was 16.8 months. Compared with patients younger than age 20 years, older patients were more likely to have a follow-up biopsy (see Table). Frequency of follow-up biopsy was lower in more recent years. Patients with a greater comorbidity burden were more likely to have a follow-up biopsy. Gender and residence in a metropolitan region did not impact the likelihood of follow-up biopsy. Among patients who had a follow-up biopsy, 57.1% had diagnostic codes for celiac disease-related symptoms in the 30 days prior to the procedure.

Discussion: Among patients with celiac disease, a follow-up biopsy was performed in 19% of cases. The practice is more common in adults than children. There were differences in frequency of follow-up biopsy based on age, comorbidity burden, and geography, but not by gender or urban versus rural residence. Many follow-up biopsies appear to be performed to investigate symptoms rather than as routine monitoring. Further research is needed to explore the impact of follow-up biopsy on outcomes.



Disclosures:


Manu V. Venkat, MD, Ling Chen, BSc, Jason D. Wright, MD, Benjamin Lebwohl, MD, MS. D0634 - Prevalence and Predictors of Follow-Up Endoscopic Biopsy in Patients With Celiac Disease in the United States, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.