Indian Journal of Pathology and Microbiology

GUIDELINE PAPER
Year
: 2021  |  Volume : 64  |  Issue : 5  |  Page : 8--31

Best practices of handling, processing, and interpretation of small intestinal biopsies for the diagnosis and management of celiac disease: A joint consensus of Indian association of pathologists and microbiologists and Indian society of gastroenterology


Prasenjit Das1, Kim Vaiphei2, Anjali D Amarapurkar3, Puja Sakhuja4, Ritambhra Nada2, Roopa Rachel Paulose5, Rachana Chaturvedi6, Anuradha Sekaran7, Usha Kini8, Archana Rastogi9, Niraj Kumari10, Anna Pulimood11, Mala Banerjee12, Prateek Kinra13, Lavleen Singh14, AmarenderSingh Puri15, Ganesh Pai16, Rakesh Kochhar17, Gopal Krishna Dhali18, BS Ramakrishna19, Ajit Sood20, Uday Chand Ghoshal21, Vineet Ahuja22, Siddhartha DattaGupta1, Govind K Makharia22, Vatsala Misra23 
1 Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
2 Department of Pathology, Post Graduate Institute of Medical Sciences and Research, Chandigarh, India
3 Department of Pathology, Lokmanya Tilak Municipal General Hospital Sion Hospital, Mumbai, Maharashtra, India
4 Department of Pathology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
5 Department of Pathology, School of Medicine, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
6 Department of Pathology, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, Maharashtra, India
7 Department of Pathology, Asian Institute of Gastroenterology and AIG Hospitals, Hyderabad, Telangana, India
8 Department of Pathology, St. John's Medical College, Bangalore, Karnataka, India
9 Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi, India
10 Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
11 Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
12 Department of Pathology, KPC Medical College and Hospital and Peerless Hospital, Kolkata, West Bengal, India
13 Department of Pathology, Armed Forces Medical College, Pune, Maharashtra, India
14 Department of Pathology, Chacha Nehru Bal Chikitsalya, New Delhi, India
15 Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
16 Department of Gastroenterology, Kuwait Hospital, Sharjah, UAE
17 Department of Gastroenterology, Post Graduate Institute of Medical Sciences and Research, Chandigarh, India
18 Department of Gastroenterology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
19 Department of Gastroenterology, SRM Institute of Medical Sciences, Chennai, Tamil Nadu, India
20 Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
21 Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
22 Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
23 Department of Pathology, MLN Medical College, Allahabad, Uttar Pradesh, India

Correspondence Address:
Govind K Makharia
Professor of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi
India
Siddhartha DattaGupta
Professor of Pathology, All India Institute of Medical Sciences, New Delhi
India
Vatsala Misra
Department of Pathology, MLN Medical College, Allahabad - 211 001, Uttar Pradesh
India

The Indian Association of Pathologists and Microbiologists (IAPM) and Indian Society of Gastroenterology (ISG) decided to make a joint consensus recommendation for handling, processing, and interpretation of SI biopsies for the diagnosis and management of celiac disease (CD) recognizing the inhomogeneous practice of biopsy sampling, orientation, processing, and interpretation. A modified Delphi process was used to develop this consensus document containing a total of 42 statements and recommendations, which were generated by sharing the document draft, incorporating expert's opinion, followed by three cycles of electronic voting as well as a full-day face-to-face virtual ZOOM meeting and review of supporting literature. Of the 42 statements, 7 statements are on small intestinal (SI) biopsy in suspected patients of CD, site and the number of biopsies; 7 on handling, fixative, orientation, processing, and sectioning in pathology laboratories; 2 on histological orientation; 13 statements on histological interpretation and histological grading; 3 on the assessment of follow-up biopsies; 2 statements on gluten-free diet (GFD)-nonresponsive CD; 4 on challenges in the diagnosis of CD; 2 statements each on pathology reporting protocol and training and infrastructure in this area. The goal of this guideline document is to formulate a uniform protocol agreed upon both by the experienced pathologists and gastroenterologists to standardize the practice, improve the yield of small bowel biopsy interpretation, patients' compliance, overall management in CD, and generate unified data for patient care and research in the related field.


How to cite this article:
Das P, Vaiphei K, Amarapurkar AD, Sakhuja P, Nada R, Paulose RR, Chaturvedi R, Sekaran A, Kini U, Rastogi A, Kumari N, Pulimood A, Banerjee M, Kinra P, Singh L, Puri A, Pai G, Kochhar R, Dhali GK, Ramakrishna B S, Sood A, Ghoshal UC, Ahuja V, DattaGupta S, Makharia GK, Misra V. Best practices of handling, processing, and interpretation of small intestinal biopsies for the diagnosis and management of celiac disease: A joint consensus of Indian association of pathologists and microbiologists and Indian society of gastroenterology.Indian J Pathol Microbiol 2021;64:8-31


How to cite this URL:
Das P, Vaiphei K, Amarapurkar AD, Sakhuja P, Nada R, Paulose RR, Chaturvedi R, Sekaran A, Kini U, Rastogi A, Kumari N, Pulimood A, Banerjee M, Kinra P, Singh L, Puri A, Pai G, Kochhar R, Dhali GK, Ramakrishna B S, Sood A, Ghoshal UC, Ahuja V, DattaGupta S, Makharia GK, Misra V. Best practices of handling, processing, and interpretation of small intestinal biopsies for the diagnosis and management of celiac disease: A joint consensus of Indian association of pathologists and microbiologists and Indian society of gastroenterology. Indian J Pathol Microbiol [serial online] 2021 [cited 2021 Oct 17 ];64:8-31
Available from: https://www.ijpmonline.org/article.asp?issn=0377-4929;year=2021;volume=64;issue=5;spage=8;epage=31;aulast=Das;type=0