Small intestine peroral biopsy in coeliac children.

Since the original description of small intestine biopsy in a coeliac child by Sakula and Shiner (1957) much has been written about this method of investigation, more as it relates to adults than to children. It is our purpose to record our experience with this technique at The Hospital for Sick Children, Great Ormond Street. Although we have studied several other conditions by this method, we shall limit our remarks to children with gluten intolerance (coeliac disease), except to give an account of one child with lactose intolerance in whom biopsy caused perforation. The diagnosis of coeliac disease rested on the usual criteria of clinical history and physical examination, supported by a variety of investigations, including fat balances, 24-hour faecal fat estimations, glucose tolerance curves, Figlu tests, barium studies of the small gut, and response to a glutenfree diet and often relapse of symptoms on restoring gluten to the diet. Between 1958 and 1964, 92 successful biopsies were performed in coeliac children. The first 29 were carried out, under general anaesthesia by Dr. Margot Shiner, using the tube which bears her name, and we are much indebted to her. However, in other hands her tube proved too difficult, which was also the experience of Cameron, Astley, Hallowell, Rawson, Miller, French, and Hubble (1962) who reported seven failures out of 13 attempts on children. For our remaining 63 successful biopsies (performed by Dr. Fry, Dr. J. A. Black, and Dr. Tempany) the Crosby-Kugler (1597) capsule was used, as a rule without sedation. We have had no experience with the Rubin tube (Brandborg, Rubin, and Quinton, 1959).