The risks of intestinal biopsy are similar to that of any moderate surgery. When it comes to the diagnosis of celiac disease, an intestinal biopsy is truly the only conclusive test available to confirm autoimmune gluten intolerance. However, in many cases, a conclusive test is not necessary and a patient can receive treatment without having to undergo such a risky procedure.
The Risks of Intestinal Biopsy
An intestinal biopsy is not considered major surgery. However, the procedure involves a mild sedative or general anesthesia and the removal of a small amount of intestinal tissue. The surgery will be done by a gastroenterologist who will conduct an endoscopy and finish the task by removing tissue from the duodenum (the first division of the small intestine). This may not sound like a seriously invasive procedure when compared to major abdominal surgeries, but unfortunately, it does not take a major surgery to produce major complications.
The first risk comes from the use of general anesthesia. Some patients are unknowingly sensitive to the anesthetic and this, unfortunately, only comes to head when the drug has already been administered. Moreover, no drug comes without risks. Some patients may be sensitive to the anesthesia and a very small number may experience long term side effects as a result of being anesthetized. General anesthesia has an effect on hypothalamic function and a lingering sense of fatigue is only one of many possible reactions. However, long term side effects are only experienced by a small number of patients and the vast majority who undergo the usage of this drug will do fine.
Also, as previously mentioned, this procedure can be executed with only a mild sedative. This process is called "conscious sedation". If possible, general anesthesia should be avoided, so ask your gastroenterologist if your biopsy can be conducted with merely the mild sedative. This is not to say the sedative is without side effects, but typically the latter will be less severe than those produced by general anesthesia.
The second risk deals with the biopsy incision. The biopsy will be relatively small; however, even a small wound is at risk for infection. Moreover, some patients may experience bowel perforations or excessive bleeding at the biopsy site. A bowel perforation can be the result of either a faulty surgeon or an intestine that is simply severely damaged. Excessive bleeding can result from numerous causes such as drug interactions or a genetic problem with insufficient clotting. Bleeding is the most commonly experienced symptom, and for this reason it is recommended patients should not take anticoagulants or aspirin for a period of time leading up to the surgery. Even eating of foods such as garlic should be avoided.
The Necessity of the Intestinal Biopsy
So, are the risks of intestinal biopsy avoidable? Some people refuse to advance to the stage of an intestinal biopsy. They may undergo blood tests for a genetic predisposition to celiac disease or a gliadin IgA test and consider their positive result enough to begin a gluten-free treatment plan. However, doctors cannot officially diagnose a patient with celiac disease until the intestinal biopsy has been performed. A categorical diagnosis is precisely what is at stake if the intestinal biopsy is avoided.
This isn't necessarily a bad thing. Sure, a patient may not be able to formerly announce his celiac status on insurance forms, but his blood tests may provide him with enough evidence to embark on a gluten free lifestyle. Sadly, this is not always the case.
The University of Chicago Celiac Disease Center reports that individuals who do not receive the intestinal biopsy diagnosis and rely only on blood test results to achieve their celiac status are not as likely to take their condition seriously. They may stray from their gluten-free diet more easily. Perhaps this is because only patients with severe debilitating symptoms are determined enough to pursue the surgical diagnostic procedure. Regardless, any individual who has received positive test results, blood or surgical, will be taking his own comfort and health at risk when he continues to include gluten-containing foods in his diet.