Small intestinal biopsy in children with coeliac disease: measurement of radiation dose and analysis of risk

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Abstract
To verify the diagnosis of coeliac disease in childhood, three consecutive small intestinal biopsies are performed under fluoroscopic control. To assess the amount of radiation dose absorbed during biopsy, dose measurements were performed both in patients and in a phantom model. These measurements were used for a theoretical assessment of cancer risk and shortening of life due to radiation exposure. The cancer excess lifetime mortality risk (CELMR) was 0.001, i.e. 1 case per 1000 children with a diagnosis of coeliac disease. The loss of life expectancy after three small intestinal biopsies in childhood was approximately 15% of the risk due to lifetime exposure to natural background radiation. These results should be compared with the reported increased risk of malignancy for undiagnosed coeliac disease in adult age. Although the excess risk of the biopsies was small, all efforts should be made to use a technique and equipment giving the least radiation dose.

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