LAUSR

Objective To determine whether development of localised protocol could reduce the number of non-targeted gastric biopsies taken at endoscopy, without risking harm from non-detection of malignant conditions. Design Retrospective analysis of patient records over a 3-month period in 2013, repeated in 2015 following intervention. Setting Two UK teaching hospitals Patients Patient record data on indication for endoscopy, endoscopy findings, histopathology results and patient outcome. Interventions Guidance on upper gastrointestinal biopsy in the form of a new trust-wide protocol, as well as lecture-based education. Main outcome measures Rates of non-targeted and targeted biopsies before and after intervention, and differences between grade of endoscopist. Results Between 2013 and 2015, there was a 36% reduction in non-targeted biopsies (10.4% vs 6.7%, p=0.001), predominantly within registrar and nurse endoscopist groups, with reduction in non-targeted biopsies of 9.5% and 64%, respectively. Percentage of targeted biopsies remained relatively static, 7.9% and 8.2%. In 2013, 92% of non-targeted biopsies had no management change based on histology; in 2015 this was 90%. Of patients with alteration to management, only 0.4% and 0.7% were due to malignancy, in known high-risk patients. Reduction in non-targeted biopsies resulted in estimated annual savings in this trust of £36,000. Conclusion Development of local protocol reduces the numbers of non-targeted biopsies taken, without risk of harm from non-detection of malignant conditions, enabling a significant reduction in workload within busy histopathology services, with significant cost savings. Localised protocols are adaptable to local population demographics.