Quality statement 3: Endoscopic intestinal biopsy

Quality statement

People referred to a specialist who need an endoscopic intestinal biopsy to diagnose coeliac disease have it within 6 weeks of referral.

Rationale

A long wait for an endoscopic intestinal biopsy can mean that some people will start a gluten-free diet to relieve symptoms and will therefore not be able to complete the diagnosis process. Limiting the time that people need to continue with a gluten-containing diet to 6 weeks or less will encourage more people to complete the diagnosis process and enable them to get the support they need.

Quality measures

Structure

Evidence of local processes to ensure that people referred to a specialist who need an endoscopic intestinal biopsy to diagnose coeliac disease have it within 6 weeks of referral.

Data source: Local data collection.

Process

a) Proportion of people referred to a specialist who need an endoscopic intestinal biopsy to diagnose coeliac disease who have it within 6 weeks of referral.

Numerator – the number in the denominator who have an endoscopic intestinal biopsy within 6 weeks of referral.

Denominator – the number of people referred to a specialist who need an endoscopic intestinal biopsy to diagnose coeliac disease.

Data source: Local data collection.

b) Proportion of people with a positive serological test for coeliac disease who complete the diagnosis process.

Numerator – the number in the denominator who complete the diagnosis process.

Denominator – the number of people with a positive serological test for coeliac disease.

Data source: Local data collection.

Outcome

Diagnosed prevalence of coeliac disease.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals, and commissioners

Service providers (secondary care) ensure that people referred to a specialist who need an endoscopic intestinal biopsy to diagnose coeliac disease have it within 6 weeks of referral.

Healthcare professionals (such as gastroenterologists and paediatricians) carry out an endoscopic intestinal biopsy to diagnose coeliac disease within 6 weeks of referral.

Commissioners (clinical commissioning groups) commission services with sufficient capacity to carry out an endoscopic intestinal biopsy to diagnose coeliac disease within 6 weeks of referral to a specialist.

What the quality statement means for patients and carers

People who have had a blood test that shows they might have coeliac disease may need a biopsy to confirm the diagnosis. The biopsy should be carried out within 6 weeks of the referral. They will need to carry on eating foods containing gluten until they have had the biopsy.

Source guidance

Definitions of terms used in this quality statement

Referral to a specialist

People aged 16 and over should be referred to a gastrointestinal specialist. Children and young people under 16 should be referred to a paediatric gastroenterologist or paediatrician with a specialist interest in gastroenterology.
[Coeliac disease (NICE guideline NG20) recommendations 1.3.1 and 1.3.2]