Letter to the Editor: Less can be more, rethinking colonic biopsy strategies for microscopic colitis in the era of green endoscopy.

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.