Agrawal H, Gupta N. Letter to the Editor: Less can be more, rethinking colonic biopsy strategies for microscopic colitis in the era of green endoscopy. World J Gastrointest Pharmacol Ther 2026; 17(3): 119904 [DOI: 10.4292/wjgpt.119904]
Corresponding Author of This Article
Nikhil Gupta, Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, BKS Marg, Delhi 110001, India. nikhil_ms26@yahoo.co.in
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Gastroenterology & Hepatology
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letter
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World Journal of Gastrointestinal Pharmacology and Therapeutics
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2150-5349
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Agrawal H, Gupta N. Letter to the Editor: Less can be more, rethinking colonic biopsy strategies for microscopic colitis in the era of green endoscopy. World J Gastrointest Pharmacol Ther 2026; 17(3): 119904 [DOI: 10.4292/wjgpt.119904]
World J Gastrointest Pharmacol Ther. Sep 5, 2026; 17(3): 119904 Published online Sep 5, 2026. doi: 10.4292/wjgpt.119904
Letter to the Editor: Less can be more, rethinking colonic biopsy strategies for microscopic colitis in the era of green endoscopy
Himanshu Agrawal, Nikhil Gupta
Himanshu Agrawal, Department of Surgery, University College of Medical Sciences (University of Delhi), GTB Hospital, Delhi 110095, India
Nikhil Gupta, Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, Delhi 110001, India
Co-first authors: Himanshu Agrawal and Nikhil Gupta.
Author contributions: Agrawal H conceptualized the article framework, performed the critical appraisal of the referenced study, drafted the initial manuscript, and revised the manuscript for important intellectual content; Gupta N contributed to the development of the central argument, provided critical revisions for scientific accuracy and policy perspective, and approved the final version of the manuscript; both authors have made crucial and indispensable contributions towards the completion of the project and thus qualified as the co-first authors of the paper.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Nikhil Gupta, Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, BKS Marg, Delhi 110001, India. nikhil_ms26@yahoo.co.in
Received: February 10, 2026 Revised: March 2, 2026 Accepted: April 10, 2026 Published online: September 5, 2026 Processing time: 199 Days and 19.1 Hours
Abstract
In this issue recently published in the World Journal of Gastrointestinal Pharmacology and Therapeutics, Leung et al present data that challenge a long-standing recommendation in microscopic colitis (MC): Routine bilateral colonic biopsies. In a large cohort of treatment-naïve patients, right-sided biopsies demonstrated a diagnostic yield of 100%, whereas left-sided biopsies were less sensitive (92%) and never independently diagnostic in this cohort when right-sided samples were available. These findings invite reconsideration of established biopsy protocols, particularly in light of value-based care and green endoscopy principles. This article examines the evidentiary basis of current guidelines, explores the implications for efficiency and sustainability, and calls for evidence-guided refinement of MC biopsy recommendations.
Core Tip: Routine bilateral colonic biopsies for suspected microscopic colitis (MC) are rooted more in tradition than contemporary evidence. Emerging data suggest that right-sided colonic biopsies alone may be sufficient for diagnosis, without compromising accuracy. Reconsidering biopsy strategies offers an opportunity to maintain diagnostic rigor while reducing procedural burden, costs, and environmental impact-aligning MC diagnosis with principles of precision and sustainable gastroenterology.
