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Dear Editor

The authors thank Dr Impellizeri for his comments.

Our strategy was purposeful. We proposed standards for the endoscopy, biopsy, and histopathological evaluation of inflammation in endoscopic biopsies of the gastrointestinal tract of dogs and cats, and, in our Guidelines, we outlined the advantages and disadvantages of biopsy derived by endoscopy (pages 13 and 14).1

An evidence-based medicine approach was used by the Group to develop the Consensus Statement. Where evidence was conflicting, ambiguous, or lacking, the Group adopted interpretive recommendations on the basis of its collective expertise.1 The evidence-based data in support of laparoscopy-derived biopsy of the jejunum, particularly with regard to safety, are still relatively minimal compared with that with endoscopy.

Single-site intestinal biopsy (eg, jejunal biopsy as suggested by Dr Impellizeri2) may not readily diagnose the spectrum of gastrointestinal tract pathology in an individual patient. Two previous studies have shown poor correlation between duodenal and ileal histopathology with abnormalities sometimes more readily detected in ileal biopsy.a,3 Consequently, we recommended biopsy from at least 2 intestinal sites—with endoscopy, the biopsy sites would be duodenal and ileal.1 Whether jejunal biopsy further differentiates and clarifies gastrointestinal tract disease remains to be determined.

Footnotes
  1. aDossin O, Tesseydre JF, Concordet D, et al. Is duodenal mucosa representative of other small intestinal parts in inflammatory bowel disease affected dogs? J Vet Intern Med 2007; 21:613 (abstract)

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