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However, in many celiac patients, their duodenum--at the time of biopsy--appears normal. This is why the surgical removal of tissue is so important, for it is only under a microscope that a definitive diagnosis of celiac disease can be made. At this point, the physician will insert a tiny surgical instrument through the tube. It reaches the small intestine, and working in concert with a surgical nurse, the physician will biopsy 5-6 areas of the small intestine. The biopsy is taken by grasping very small sections of tissue and slicing them gently away from the walls of the intestine. Multiple tissue samples are also vital to an accurate diagnosis—celiac disease can cause patchy lesions in the duodenum which can be missed if only one or two samples are taken. Results of the biopsy will confirm if a patient has celiac disease. There are no nerve endings in the intestine, so this procedure does not cause pain in the gut. Afterwards, some patients experience a sore throat, but most have no memory of the procedure.