{
  "abstract": "Introduction Microscopic colitis (MC) is a cause of chronic diarrhoea and is diagnosed histologically on colonic biopsies. BSG/ESGE guidelines suggest 2 right sided and 2 left side colonic biopsies for diagnosis (Arasaradnam RP et al., Gut 2018; Miehlke S et al., UEG Journal 2021). We noted variable biopsy practice amongst endoscopists in our department and completed a QIP to improve local adherence to guidelines.Methods We conducted a two-cycle QIP assessing compliance with biopsy guidelines for suspected MC. Data was obtained from the endoscopy reporting system and electronic patient records. Patients with chronic diarrhoea, with no endoscopic cause, were included. Patients with inflammatory bowel disease, malignancy, or alternative indications for biopsy were excluded. The 1st cycle was a retrospective audit of colonoscopies performed for chronic diarrhoea between November 2024 and January 2025. The results of the audit were presented at a local Endoscopy Users Group Meeting, and guidance on biopsy protocols was sent to endoscopists via departmental email communication. Following this, a 2nd prospective re-audit was done between July and September 2025 to assess the impact of the intervention. Data collected included the number and anatomical location of biopsies, use of additional specimen pots, associated costs, histopathology processing time, and final diagnosis. Cost analysis focused on excess specimen pots (£40/pot) and additional histopathology time (5 min/biopsy).Results In the 1st cycle, compliance with recommended biopsy guidelines for suspected MC was only 10%. A total of 500 extra biopsies were taken, requiring extra pots costing £3,560 and 2,500 minutes of extra histopathology processing time. Seven patients were diagnosed with MC during this cycle. The diagnostic yield was 100% (7/7) when both right- and left-sided biopsies were taken, compared to 71% (5/7) for rectal-only biopsies.After the intervention the compliance improved to 93.2%, with extra biopsies reduced to 20, lowering the cost of additional pots to £240 and the histopathology processing time to 100 minutes (table 1).Conclusions Our QIP improved adherence to biopsy guidelines for MC, resulting in estimated savings (approximately £12,000/ year), reducing additional time and costs for the histopathology team, and contributing to more sustainable, green endoscopy practice.Abstract P353 Table 1Summary of audit cyclesTotal PatientsCompliance (%)Biopsy Proven MCExtra BiopsiesCost of extra pots (£)Extra time spent(min)Cycle 110010750035602500Cycle 28793.20320240100",
  "authors": [
    {
      "affiliations": [
        "Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom"
      ],
      "name": "Adnan Shabbir"
    },
    {
      "affiliations": [
        "Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom"
      ],
      "name": "Samir Sulaiman"
    },
    {
      "affiliations": [
        "Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom"
      ],
      "name": "Nada Al-Khazraji"
    },
    {
      "affiliations": [
        "Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom"
      ],
      "name": "Rafiq Ullah"
    },
    {
      "affiliations": [
        "Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom"
      ],
      "name": "Samuel Smith"
    }
  ],
  "title": "P353 Optimisation of colonic biopsy protocols for microscopic colitis: a departmental QIP",
  "uid": "ee2208e6-a02c-55a6-bec8-a17e8712726d"
}