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Background Coeliac disease (CD) is a systemic immune-mediated disorder caused by the ingestion of gluten and related prolamines in genetically predisposed individuals. The 2012 ESPGHAN guidelines suggested a no-biopsy pathway (NBP) for symptomatic children with IgA-based Tissue Transglutaminase (TGA-IgA) -10x Upper Limit of Normal (ULN). Biopsy confirmation remained mandatory for all other cases. Objectives This retrospective case note study was aimed at evaluating the extent of adherence to the ESPGHAN 2012 guidelines for diagnosing CD in our unit. Methods 179 cases with positive TGA-IgA were identified from the laboratory database between January'2013 to December' 2020. 17/179 (9%) patients were not referred to secondary care after the finding of positive TTG in primary care. Data was collected on the diagnostic pathways followed, and adherence was compared with the existing ESPGHAN 2012 guidelines. Results 129 cases assessed for CD were included and 124 children diagnosed with CD. 68/129 (53%) were diagnosed via the NBP. 57/68 were diagnosed via NBP until December 2019 and 24/57 (42%) children did not meet triple criteria as per 2012 ESPGHAN guidelines. HLA-DQ2/DQ8 testing wasn't done for 16/57 NBP cases and other 3/57 had a negative EMA result. In 2020, 13 patients were diagnosed via NBP, 11 in adherence to the 2020 ESPGHAN guidelines, other 2 [TGA-IgA