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Pouw RE, Barret M, Biermann K, Bisschops R, Czakó L, Gecse KB, de Hertogh G, Hucl T, Iacucci M, Jansen M, Rutter M, Savarino E, Spaander MCW, Schmidt PT, Vieth M, Dinis-Ribeiro M, van Hooft JE. Endoscopic tissue sampling - Part 1: Upper gastrointestinal and hepatopancreatobiliary tracts. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2021; 53:1174-1188. [PMID: 34535035 DOI: 10.1055/a-1611-5091] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
1: ESGE recommends that, where there is a suspicion of eosinophilic esophagitis, at least six biopsies should be taken, two to four biopsies from the distal esophagus and two to four biopsies from the proximal esophagus, targeting areas with endoscopic mucosal abnormalities. Distal and proximal biopsies should be placed in separate containers.Strong recommendation, low quality of evidence. 2: ESGE recommends obtaining six biopsies, including from the base and edge of the esophageal ulcers, for histologic analysis in patients with suspected viral esophagitis.Strong recommendation, low quality of evidence. 3: ESGE recommends at least six biopsies are taken in cases of suspected advanced esophageal cancer and suspected advanced gastric cancer.Strong recommendation, moderate quality of evidence. 4: ESGE recommends taking only one to two targeted biopsies for lesions in the esophagus or stomach that are potentially amenable to endoscopic resection (Paris classification 0-I, 0-II) in order to confirm the diagnosis and not compromise subsequent endoscopic resection.Strong recommendation, low quality of evidence. 5: ESGE recommends obtaining two biopsies from the antrum and two from the corpus in patients with suspected Helicobacter pylori infection and for gastritis staging.Strong recommendation, low quality of evidence. 6: ESGE recommends biopsies from or, if endoscopically resectable, resection of gastric adenomas.Strong recommendation, moderate quality of evidence. 7: ESGE recommends fine-needle aspiration (FNA) and fine-needle biopsy (FNB) needles equally for sampling of solid pancreatic masses.Strong recommendation, high quality evidence. 8: ESGE suggests performing peroral cholangioscopy (POC) and/or endoscopic ultrasound (EUS)-guided tissue acquisition in indeterminate biliary strictures. For proximal and intrinsic strictures, POC is preferred. For distal and extrinsic strictures, EUS-guided sampling is preferred, with POC where this is not diagnostic.Weak recommendation, low quality evidence. 9: ESGE suggests obtaining possible non-neoplastic biopsies before sampling suspected malignant lesions to prevent intraluminal spread of malignant disease.Weak recommendation, low quality of evidence. 10: ESGE suggests dividing EUS-FNA material into smears (two per pass) and liquid-based cytology (LBC), or the whole of the EUS-FNA material can be processed as LBC, depending on local experience.Weak recommendation, low quality evidence.
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Affiliation(s)
- Roos E Pouw
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Cancer Center Amsterdam, Amsterdam University Medical Centers location VUmc, Amsterdam, The Netherlands
| | - Maximilien Barret
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital and University of Paris, Paris, France
| | - Katharina Biermann
- Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - László Czakó
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Krisztina B Gecse
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers location AMC, Amsterdam, The Netherlands
| | - Gert de Hertogh
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Tomas Hucl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Marietta Iacucci
- Institute of Translational Medicine, Institute of Immunology and Immunotherapy and NIHR Birmingham Biomedical Research Centre, University Hospitals NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Marnix Jansen
- Department of Histopathology, University College London Hospital, London, UK
| | - Matthew Rutter
- Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK
| | - Edoardo Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Peter T Schmidt
- Department of Medicine (Solna), Karolinska Institute and Department of Medicine, Ersta Hospital, Stockholm, Sweden
| | - Michael Vieth
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg, Klinikum Bayreuth, Bayreuth, Germany
| | - Mário Dinis-Ribeiro
- Department of Gastroenterology, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
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Gibson JA, Odze RD. Tissue Sampling, Specimen Handling, and Laboratory Processing. CLINICAL GASTROINTESTINAL ENDOSCOPY 2019:51-68.e6. [DOI: 10.1016/b978-0-323-41509-5.00005-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Bottero E, Mussi E, Pieramati C, De Lorenzi D, Silvestri S, Lepri E. Comparison of 2 differently sized endoscopic biopsy forceps in the evaluation of intestinal disease in cats. J Vet Intern Med 2018; 33:523-530. [PMID: 30556184 PMCID: PMC6430887 DOI: 10.1111/jvim.15356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 10/05/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND In clinical practice, histopathological diagnosis of chronic intestinal disease is challenging because of difficulty in obtaining adequate duodenal samples. At present, no studies have investigated the influence of biopsy forceps size on sample quality in cats. OBJECTIVES Duodenal biopsy using larger biopsy forceps (2.4 mm) will provide higher quality samples. ANIMALS Fifty client-owned cats underwent endoscopy of the upper gastrointestinal tract for evaluation of chronic gastrointestinal signs, with inflammatory bowel disease (IBD) or intestinal lymphoma as differential diagnoses. METHODS For each cat, duodenal biopsy specimens were obtained using both small (1.8 mm) and large (2.4 mm) forceps and evaluated for adequacy, orientation, the presence of artifacts, villi morphology, the presence of inflammation, and neoplastic infiltration. RESULTS The percentage of adequate and evaluable biopsy specimens obtained using the larger forceps was significantly higher than that collected using the smaller forceps. Agreement between the forceps was variable for histological features and substantial in the case of lymphoma. However, in case of disagreement, the proper diagnosis usually was achieved only with the larger biopsy forceps. CONCLUSIONS AND CLINICAL IMPORTANCE Use of a larger biopsy forceps allows collection of a higher percentage of adequate and evaluable biopsy specimens compared to the commonly used smaller forceps and indirectly decreases the percentage of artifacts and increases the percentage of samples with evaluable villi. The use of a larger forceps could be helpful to obtain high-quality samples and improve diagnostic accuracy.
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Affiliation(s)
- Enrico Bottero
- Poliambulatorio Argentina, Freelance Gruppo Endovet, Arma di Taggia, Italy
| | - Emanuele Mussi
- Clinica Veterinaria Croce Azzurra, Freelance Gruppo Endovet, Empoli, Italy
| | - Camillo Pieramati
- Dipartimento di Medicina Veterinaria, University of Perugia, Perugia, Italy
| | | | | | - Elvio Lepri
- Dipartimento di Medicina Veterinaria, University of Perugia, Perugia, Italy
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Edery EG, Scase T, Kisielewicz C, Dhumeaux MP. Comparison of standard single-bite with multiple-bite biopsy forceps for collection of gastrointestinal biopsies in dogs: a prospective study. Vet Rec 2018; 183:624. [PMID: 30115670 DOI: 10.1136/vr.104742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 07/15/2018] [Accepted: 07/25/2018] [Indexed: 11/04/2022]
Abstract
Various types of endoscopic biopsy forceps have been investigated in dogs. The Multibite (MB) are multiple-bite forceps that collect up to four tissue specimens in a single pass through the endoscope, reducing procedure time. The authors prospectively investigated its clinical utility by comparing procedure times and diagnostic quality of samples obtained with the MB to that of biopsies performed with a single-bite forceps (SB), in 21 dogs with gastrointestinal disorders. When comparing the depth, crush artefacts and diagnostic adequacy of the gastric and duodenal biopsies, there was no significant difference between the MB and SB forceps. The procedure time was significantly longer with the MB. There was no learning curve effect, and there were no reported adverse events. This study failed to demonstrate any significant clinical advantage associated with the use of the Multibite forceps over that of conventional disposable SB forceps.
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Reggiani Bonetti L, Manta R, Manno M, Conigliaro R, Missale G, Bassotti G, Villanacci V. Optimal processing of ESD specimens to avoid pathological artifacts. Tech Coloproctol 2018; 22:857-866. [PMID: 30560321 DOI: 10.1007/s10151-018-1887-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 11/19/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND En bloc endoscopic submucosal dissection (ESD) has been recently introduced as a treatment for precancerous/neoplastic gastrointestinal conditions. The aim of the present study was histological assessment of en bloc ESD specimens. METHODS Fifty-three ESD specimens were positioned over a cellulose acetate support (40 specimens; 12 from the upper gastrointestinal tract and 28 from the lower gastrointestinal tract) or pinned with nails on polystyrene or cork (13 specimens; 7 from the upper gastrointestinal tract and 6 from the lower gastrointestinal tract). We cut consecutive 2 mm-thick sections stained with hematoxylin and eosin. From the first and the last sections, we obtained a second slide, after a 180° rotation and re-embedding. The quality of ESD samples was scored as inadequate, suboptimal and adequate, based on the amount of crushing, shearing and stretching artifacts that were scored from 0 (absent) to 2 (diffuse or maximum). From the sum of these we obtained a global artifact score (GAS). RESULTS Removed lesions were: adenocarcinoma (5 cases), neuroendocrine tumor (NET) G1 (1 case), premalignant conditions, including adenomatous polyps (41 cases) and hyperplastic lesions (6 cases). A positive deep surgical margin was found in 8/53 cases (15%): high- and low-grade dysplastic glands were detected in 5 cases, low-grade adenocarcinoma in 2, and NET cells in 1. Dysplastic glands were detected in the lateral surgical margins of 12 ESD specimens (23%). Among the ESD specimens positioned on the cellulose acetate support, apart from the modifications due to electrocoagulation, 2 (5%) showed shearing modifications. In the group of ESD specimens fixed with nails, 5 (38%) showed shearing, 10 (77%) crushing artifacts, 11 (85%) stretching and 11 (85%) multiple holes caused by the nails. On the basis of these data all histological specimens from ESD on cellulose acetate were adequate (GAS 0-1).However, in the group of ESD fixed with nails, 1 was adequate (GAS 0), 11 suboptimal (GAS 2-5) and 1 inadequate (GAS 6). CONCLUSIONS Specific devices including cellulose support and adequate sampling blocks can be helpful to perform accurate histological assessment of ESD specimens after en bloc ESD for precancerous/neoplastic gastrointestinal lesions, with complete analysis of the status of the margins and the entirely en bloc evaluation of the lesion.
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Affiliation(s)
- L Reggiani Bonetti
- Institute of Pathology of Modena Az., Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy.
- Department of Diagnostic Medicine and Public Health, University of Modena and Reggio Emilia Section of Pathology, Via del Pozzo 71, 41100, Modena, Italy.
| | - R Manta
- Endoscopy Unit Ospedale Baggiovara, (NOCSAE), Baggiovara, Italy
| | - M Manno
- Digestive Endoscopy Unit, Carpi Hospital, Modena, Italy
| | - R Conigliaro
- Endoscopy Unit Ospedale Baggiovara, (NOCSAE), Baggiovara, Italy
| | - G Missale
- Endoscopy Unit Spedali Civili, Brescia, Italy
| | - G Bassotti
- Gastroenterology and Hepatology Section, Department of Medicine, University of Perugia School of Medicine, Perugia, Italy
| | - V Villanacci
- Institute of Pathology Spedali Civili, Brescia, Italy
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Zimmon DS, Smith FB, Manheimer F, Fan C, Njiwaji C, Aksenov S, Chattoo P. Endoscopic multiple biopsy and rapid diagnosis by in situ fixation and histopathologic processing. Gastrointest Endosc 2017; 86:333-342. [PMID: 27988287 DOI: 10.1016/j.gie.2016.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 12/04/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Endoscopic forceps biopsy and fixation are laborious and prolong the procedure and anesthesia. Multiple biopsy overcomes these shortcomings with a single endoscope pass that cuts, like a needle biopsy, up to 25 biopsy samples of uniform size and depth during endoscope withdrawal. Biopsy specimens are collected in acquisition order and stored in a perforated plastic storage chamber within the perforated metal tip. The tip is cut off, immersed in fixative, and sent to pathology. A formatted log identifies each biopsy specimen by site and position. In pathology, the plastic storage cylinder, designed for processing and microtomy with biopsy specimens in situ, supports rapid diagnosis by frozen section and microwave or routine paraffin processing. METHODS After a 10-patient Institutional Review Board safety study and US Food and Drug Administration registration, biopsies were performed in 57 patients during colonoscopy, upper GI endoscopy, and ERCP. A blinded retrospective study compared colon surveillance biopsies in 15 patients who underwent multiple biopsy with 15 patients who underwent forceps biopsies performed by anonymous physicians on the same day. Patient information was removed from slides, and forceps biopsies were oriented manually for blinding. RESULTS Multiple biopsy specimens fixed and processed in situ were not significantly different from batched processed forceps biopsy specimens for depth, orientation, fixation, artifacts, and diagnostic information. Multiple biopsy colonic specimens were significantly (26%) smaller with better epithelial preservation than forceps specimens. Each biopsy saves 61 seconds during withdrawal. CONCLUSIONS Single-pass multiple biopsy reduces biopsy time with less specimen damage, work, workplace risk, and soiling. Diagnostic quality is equal to forceps biopsy with better epithelial preservation, although 26% smaller. In pathology, in situ processing and microtomy reduce work and workplace risk. Grossing and manual orientation are unnecessary. Rapid diagnosis by frozen section and microwave or paraffin processing are facilitated. Multiple biopsy speeds diagnosis and improves productivity in endoscopic biopsy and histopathologic processing.
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Affiliation(s)
- David S Zimmon
- Department of Medicine, New York Downtown Hospital, New York, New York, USA; Department of Medicine, St. Vincent's Hospital, New York, New York, USA
| | - Fred B Smith
- Department of Pathology, St. Vincent's Hospital, New York, New York, USA
| | - Forrest Manheimer
- Department of Medicine, New York Downtown Hospital, New York, New York, USA; Department of Medicine, St. Vincent's Hospital, New York, New York, USA
| | - Cathy Fan
- Department of Pathology, St. Vincent's Hospital, New York, New York, USA
| | - Chantel Njiwaji
- Department of Pathology, St. Vincent's Hospital, New York, New York, USA
| | - Sergei Aksenov
- Department of Pathology, St. Vincent's Hospital, New York, New York, USA
| | - Premtesh Chattoo
- Department of Medicine, New York Downtown Hospital, New York, New York, USA; Department of Medicine, St. Vincent's Hospital, New York, New York, USA
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Dahan J, Semin MO, Monton C, Amiriantz S, Concordet D, Raymond-Letron I, Dossin O. Comparison of routinely used intestinal biopsy forceps in dogs: an ex vivo histopathological approach. J Small Anim Pract 2017; 58:162-167. [PMID: 28267217 DOI: 10.1111/jsap.12643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 11/18/2016] [Accepted: 12/05/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To compare the quality of duodenal and ileal samples obtained with different biopsy forceps. METHODS Fifteen dogs were included in a prospective ex vivo study. After euthanasia, the duodenum and the ileum were sampled with four different forceps and evaluated according to a standardised scoring system. The biopsy forceps evaluated had alligator jaws or cups with smooth edge with or without a needle. RESULTS The global quality of the biopsies was better in the ileum that in the duodenum regardless of the biopsy forceps. Biopsy forceps with smooth edge including a needle resulted in fewer artefacts than biopsy forceps with smooth edge but no needle in both sites and those with alligator jaws without a needle provided deeper biopsies than those with smooth edge without a needle only in the duodenum. There was no effect of the biopsy forceps type on the size of the biopsies. CLINICAL SIGNIFICANCE Our findings may aid in choosing the appropriate type of forceps for intestinal biopsy.
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Affiliation(s)
- J Dahan
- Department of Clinical Sciences and Clinical Research Unit, National Veterinary School - INP, University of Toulouse, Toulouse, France
| | - M O Semin
- Department of Biological Sciences, National Veterinary School - INP, University of Toulouse, Toulouse, France
| | - C Monton
- Department of Clinical Sciences and Clinical Research Unit, National Veterinary School - INP, University of Toulouse, Toulouse, France
| | - S Amiriantz
- Department of Clinical Sciences and Clinical Research Unit, National Veterinary School - INP, University of Toulouse, Toulouse, France
| | - D Concordet
- Department of Biological Sciences, National Veterinary School - INP, University of Toulouse, Toulouse, France
| | - I Raymond-Letron
- Department of Biological Sciences, National Veterinary School - INP, University of Toulouse, Toulouse, France
| | - O Dossin
- Department of Clinical Sciences and Clinical Research Unit, National Veterinary School - INP, University of Toulouse, Toulouse, France.,IRSD, INSERM 1220, INSERM, INRA, ENVT, UPS, University of Toulouse, 31024 Toulouse, France
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8
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Maximizing the diagnostic utility of endoscopic biopsy in dogs and cats with gastrointestinal disease. Vet J 2016; 214:50-60. [DOI: 10.1016/j.tvjl.2016.04.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 03/26/2016] [Accepted: 04/14/2016] [Indexed: 02/06/2023]
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Comparison of Performance Characteristics of Oval Cup Forceps Versus Serrated Jaw Forceps in Gastric Biopsy. Dig Dis Sci 2016; 61:2338-2343. [PMID: 27003145 DOI: 10.1007/s10620-016-4129-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 03/10/2016] [Indexed: 12/09/2022]
Abstract
BACKGROUND Obtaining quality endoscopic biopsy specimens is vital in making successful histological diagnoses. The influence of forceps cup shape and size on quality of biopsy specimens is unclear. AIM To identify whether oval cup or two different serrated jaw biopsy forceps could obtain specimens of superior size. Secondary endpoints were tissue adequacy, depth of tissue acquisition, and crush artifact. METHODS A single-center, prospective, pathologist-masked, randomized controlled trial was performed. In total 136 patients with a clinical indication for esophagogastroduodenoscopy with biopsy were randomized to receive serial biopsies with a large-capacity serrated forceps with jaw diameter 2.2 mm (SER1) and either a large-capacity oval forceps with jaw diameter 2.4 mm (OVL) or large-capacity serrated biopsy forceps with jaw diameter 2.4 mm (SER2) in two parallel groups. RESULTS SER2 provided significantly larger specimens than did the other forceps (SER2 3.26 ± 1.09 vs. SER1 2.92 ± 0.88 vs. OVL 2.92 ± 0.76; p = 0.026), with an average size difference of 0.34 mm greater with SER2 compared to SER1 and OVL. OVL provided significantly deeper biopsies compared to SER1 and SER2 (p = 0.02), with 31 % of OVL biopsies reaching the submucosa. SER2 had significantly less crush artifact than SER1 and OVL (p < 0.0001). CONCLUSION Serrated forceps provided larger samples compared to oval jaw forceps of the same size, with SER2 providing the largest specimen size. Oval cup forceps had deeper penetration of epithelium, while the larger jaw diameter serrated jaw forceps had less crush artifact. All three forceps provided specimens adequate for diagnostic purposes.
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Ruiz GC, Reyes-Gomez E, Hall EJ, Freiche V. Comparison of 3 Handling Techniques for Endoscopically Obtained Gastric and Duodenal Biopsy Specimens: A Prospective Study in Dogs and Cats. J Vet Intern Med 2016; 30:1014-21. [PMID: 27396683 PMCID: PMC5108414 DOI: 10.1111/jvim.14403] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 05/07/2016] [Accepted: 06/15/2016] [Indexed: 12/28/2022] Open
Abstract
Background Limited evidence exists in the literature regarding whether a specific mount is preferable to use for processing endoscopically obtained gastrointestinal biopsy specimens. Hypothesis/Objectives To compare 3 methods of handling endoscopically obtained gastrointestinal biopsy specimens from collection to laboratory processing and to determine if any technique produced superior results. Animals Twenty‐three dogs and cats presented for gastrointestinal signs. Methods Prospective study of dogs and cats presented with gastrointestinal signs to a veterinary teaching referral hospital which underwent upper gastrointestinal endoscopy. Biopsy specimens were taken from the stomach and duodenum and submitted to the laboratory using 3 techniques: mounted on a cucumber slice, mounted on a moisturized synthetic foam sponge, and floating free in formalin. The techniques were compared with regard to the specimens' width, orientation, presence of artifacts, and pathologist's confidence in diagnosis. Results Twenty‐three patients were included, with a total of 528 biopsies collected. Specimens on cucumber slice and on sponge were significantly wider (P < .001 and P = .001, respectively) compared to those floating free in formalin (mean width of 3.81 versus 3.31 and 2.52 mm, respectively). However, specimens on synthetic sponge had significantly fewer artifacts compared to those on cucumber slice (P = .05) and those floating free in formalin (P = .02). Confidence in the diagnosis also was superior with the sponge technique over floating free specimens (P = .002). Conclusions and Clinical Importance The use of mounted gastrointestinal biopsy specimens was superior over the use of specimens floating free in formalin. This technique improved the quality of the specimens and the pathologist's confidence in their histopathologic interpretation.
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Affiliation(s)
- G C Ruiz
- Internal Medicine Department, Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort Cedex, France.,Langford Veterinary Services, Internal Medicine Department, Small Animal Referral Hospital, University of Bristol, Langford, UK
| | - E Reyes-Gomez
- Anatomical Pathology Unit, Biopôle, Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort Cedex, France
| | - E J Hall
- Langford Veterinary Services, Internal Medicine Department, Small Animal Referral Hospital, University of Bristol, Langford, UK
| | - V Freiche
- Internal Medicine Department, Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort Cedex, France
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Cartwright JA, Hill TL, Smith S, Shaw D. Evaluating Quality and Adequacy of Gastrointestinal Samples Collected using Reusable or Disposable Forceps. J Vet Intern Med 2016; 30:1002-7. [PMID: 27255591 PMCID: PMC5089600 DOI: 10.1111/jvim.14354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 04/01/2016] [Accepted: 05/12/2016] [Indexed: 12/27/2022] Open
Abstract
Background Sample quality of gastrointestinal endoscopic biopsies is of paramount importance for accurate histological diagnosis. Many veterinary practices use reusable forceps as a result of perceived decreased cost. With reusable forceps, it remains unknown whether sample quality declines with repeated use and becomes inferior to single‐use forceps and is therefore more or less cost effective than single‐use forceps. Hypothesis/Objectives The study hypothesis was that reusable forceps sample quality would deteriorate after repeated use as compared to single‐use forceps. Animals Sixty‐five dogs undergoing gastrointestinal endoscopy for diagnostic investigations at the Hospital for Small Animals, Edinburgh University. Method A prospective, pathologist‐blinded study comparing single‐use and reusable alligator standard cup biopsy forceps (Olympus 2.0 mm 1550 mm) with 5 randomized reusable forceps. Sample quality (stomach, duodenum, ileum, and colon) was assessed by a single pathologist using the WSAVA guidelines. Results There was no difference in the adequacy, depth, villi number, or crush artifact in the 4 intestinal areas between forceps type with at least 10, and up to 15, repeated uses of the reusable forceps. Conclusions and clinical importance This study demonstrates that reusable cup biopsy forceps provide equivalent biopsy quality after repeated uses to single‐use forceps and are cost effective at 10‐case use.
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Affiliation(s)
- J A Cartwright
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA, 30602
| | - T L Hill
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA, 30602
| | - S Smith
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA, 30602
| | - D Shaw
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA, 30602
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12
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BRAF V600E immunohistochemistry is reliable in primary and metastatic colorectal carcinoma regardless of treatment status and shows high intratumoral homogeneity. Am J Surg Pathol 2014; 38:1418-28. [PMID: 24921639 DOI: 10.1097/pas.0000000000000263] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In colorectal carcinoma the evaluation of BRAF mutation status is increasingly being performed given its utility as a prognostic and predictive biomarker. However, there are conflicting reports of the sensitivity and specificity of BRAF V600E immunohistochemistry (IHC), and little is known about its reliability in tissues collected from metastatic sites or after chemotherapy, radiation therapy and/or targeted therapy. The degree of intratumoral staining heterogeneity is also not well established. We performed IHC for BRAF V600E (VE1) on 204 cases of colorectal carcinoma including 59 with the BRAF V600E mutation. These included primary (n=147) and metastatic/recurrent (n=57) tumors, collected before (n=133) or after (n=71) chemotherapy, radiation therapy and/or targeted therapy. Evaluation of a test cohort (39 cases) with knowledge of mutation status established a specific staining pattern for the mutation: diffuse cytoplasmic staining of near-uniform intensity, regardless of strength of staining. Using this pattern, pathologists at 3 levels of training independently performed blinded evaluation of the remaining cases. BRAF V600E staining was 96.3% sensitive and 98.5% specific for the mutation, including both pretreatment and posttreatment specimens. Fleiss κ for interobserver agreement was 0.96. Staining of whole sections of the BRAF mutants showed diffuse staining in all cases and uniform or near-uniform intensity in 91%. In 20 cases with both pretreatment and posttreatment specimens, there was 100% accuracy and agreement in staining between samples. We conclude that BRAF V600E IHC is reliable for the evaluation of mutational status in colorectal carcinoma regardless of site or prior treatment history, and staining shows a high degree of intratumoral homogeneity.
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Goutal-Landry C, Mansell J, Ryan K, Gaschen F. Effect of Endoscopic Forceps on Quality of Duodenal Mucosal Biopsy in Healthy Dogs. J Vet Intern Med 2013; 27:456-61. [DOI: 10.1111/jvim.12085] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 12/12/2012] [Accepted: 03/07/2013] [Indexed: 12/25/2022] Open
Affiliation(s)
- C.M. Goutal-Landry
- Department of Veterinary Clinical Sciences; School of Veterinary Medicine; Louisiana State University; Baton Rouge LA
| | - J. Mansell
- College of Veterinary Medicine; University of Texas A&M; College Station TX
| | - K.A. Ryan
- Department of Veterinary Clinical Sciences; School of Veterinary Medicine; Louisiana State University; Baton Rouge LA
| | - F.P. Gaschen
- Department of Veterinary Clinical Sciences; School of Veterinary Medicine; Louisiana State University; Baton Rouge LA
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Rhee KH, Han HS, Lee SY, Seo TH, Ko SY, Kim BK, Sung IK, Jin CJ, Min YI. Does a small biopsied gastric specimen limit the usage of two directional transnasal esophagogastroduodenoscopy? J Gastroenterol Hepatol 2010; 25:270-6. [PMID: 19968748 DOI: 10.1111/j.1440-1746.2009.06029.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIMS It is difficult to approach certain gastric regions due to the limited bending ability of transnasal esophagogastroduodenoscopy (TN-EGD). We analyzed the TN-EGD biopsied specimens according to where they were obtained inside the stomach. METHODS Two hundred and eighty-nine gastric biopsy specimens were obtained during diagnostic TN-EGD. The gastric biopsied specimens were quantified according to their diameter and depth in micrometers, and depth in layers (superficial mucosa, deep mucosa, muscularis mucosa and submucosa). The quality was measured by the degrees of anatomical orientation (good, intermediate and poor), presence of crush artifact (none to minimal, mild and moderate) and overall diagnostic adequacy (adequate, suboptimal and inadequate). RESULTS Poor orientation, presence of crush and overall diagnostic inadequacy were present in 33 (11.4%), 26 (9.0%) and 37 (12.8%) of the 289 specimens, respectively. Deep mucosa was present in 211 specimens (73.0%), while muscularis mucosa was present in only 75 specimens (26.0%). Specimens taken from the posterior aspect of the cardia exhibited the shallowest depth (P = 0.011), poorest orientation (P < 0.001) and poorest diagnostic adequacy (P < 0.001). Fluoroscopic findings demonstrated that the posterior aspect of the cardia was difficult to approach closely and perpendicularly because of the anatomical configuration of the stomach in nature. CONCLUSION TN-EGD biopsied specimens obtained from the posterior aspect of the cardia exhibit limitations in both quality and quantity. When performing a biopsy using two directional TN-EGD, special attention should be paid to gastric lesions located on the posterior aspect of the cardia.
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Affiliation(s)
- Kyoung Hoon Rhee
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
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Washabau R, Day M, Willard M, Hall E, Jergens A, Mansell J, Minami T, Bilzer T. Endoscopic, Biopsy, and Histopathologic Guidelines for the Evaluation of Gastrointestinal Inflammation in Companion Animals. J Vet Intern Med 2010; 24:10-26. [DOI: 10.1111/j.1939-1676.2009.0443.x] [Citation(s) in RCA: 281] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Use of a new jumbo forceps improves tissue acquisition of Barrett's esophagus surveillance biopsies. Gastrointest Endosc 2009; 70:1072-8.e1. [PMID: 19595312 DOI: 10.1016/j.gie.2009.04.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2009] [Accepted: 04/10/2009] [Indexed: 12/20/2022]
Abstract
BACKGROUND The major risk factors for the development of esophageal adenocarcinoma remain long-standing GERD and resultant Barrett's esophagus (BE). Finding the exact method of adequate tissue sampling for surveillance of dysplasia in BE remains a dilemma. OBJECTIVE We prospectively compared standard large-capacity biopsy forceps with a new jumbo biopsy forceps for dysplasia detection in BE. SETTING/DESIGN Prospective, single-center investigation. PATIENTS/INTERVENTIONS We prospectively enrolled 32 patients undergoing surveillance endoscopy for BE. Biopsy samples were obtained in paired fashion alternating between the experimental (jumbo) and control (large-capacity) forceps. MAIN OUTCOME MEASUREMENTS Each sample was assessed for histopathology, specimen size, and adequacy. RESULTS A total of 712 specimens were available for analysis for this investigation. Six patients were found to have dysplasia, and in 5 of those patients, the dysplasia was only detected with the jumbo forceps. The mean width was significantly greater in the Radial Jaw 4 jumbo group (3.3 mm vs 1.9 mm [P < .005]) as was the mean depth (2.0 mm vs 1.1 mm [P < .005]). Sixteen percent of samples obtained with the standard forceps provided an adequate sample, whereas the jumbo forceps provided an adequate sample 79% of the time (P < .05). LIMITATIONS A lack of a validated index for assessment of tissue adequacy in BE. CONCLUSION The Radial Jaw 4 jumbo biopsy forceps significantly improves dysplasia detection and adequate tissue sampling in patients undergoing endoscopy for BE.
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Rodrigues NLF, Doré M, Doucet MY. Validation of a transendoscopic glandular and nonglandular gastric biopsy technique in horses. Equine Vet J 2009; 41:631-5. [PMID: 19927580 DOI: 10.2746/042516409x424144] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
REASONS FOR PERFORMING STUDY In order to study the evolution of histopathological and immunohistochemical changes in the gastric mucosa of horses with EGUS (equine gastric ulcer syndrome), a feasible, useful, valid and safe in vivo gastric biopsy technique is required. OBJECTIVES To determine the average gastric mucosal healing time following endoscopic gastric biopsy sampling, and evaluate the feasibility, safety and usefulness of samples obtained by this method for histopathological analysis. METHODS Six mature mares from the Faculté de Médecine Vétérinaire research herd were used. Transendoscopic gastric biopsy was performed on Days 0 and 9 using a flexible forceps with oval and fenestrated jaws to obtain gastric mucosal samples from 4 different sites: cardia (C), fundus (F), margo plicatus (MP) and glandular mucosa (GL). A maximum of 4 samples per site was taken and processed routinely for histopathology, evaluated by a pathologist. On Days 1-4 and 9-11 the lesions created by the biopsies were evaluated by gastroscopy. Lesions were evaluated over time based on a score from 0-4, where 4 was the most severe. RESULTS Biopsy samples could be obtained from all targeted sites except C. No abnormal clinical signs were observed up to 7 days post biopsy. The average biopsy lesion scores decreased significantly with time for all sites. The average lesion score was significantly higher for the MP compared to the other sites at Days 1 and 2. Samples taken from the nonglandular portion of the stomach were considered inadequate for histopathology, while those taken from the glandular mucosa were adequate. CONCLUSION The transendoscopic gastric biopsy technique described here is a feasible, safe and useful technique for obtaining samples from the equine gastric glandular mucosa. Although biopsy samples could be obtained from several areas in the nonglandular mucosa, these were very small, took longer to heal and were not considered adequate for histopathological evaluation, and another technique should therefore be validated.
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Affiliation(s)
- N L F Rodrigues
- Département de Biomédecine Vétérinaire, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, Québec, Canada
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Abstract
Flexible endoscopy is a valuable tool for the diagnosis of many small animal digestive tract diseases. This article provides a basic introduction to small animal gastrointestinal endoscopy including its diagnostic advantages as well as its limitations and complications. Although proficiency in endoscopic techniques can only be obtained through many hours of practice, this article should also encourage and stimulate the novice endoscopist.
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Affiliation(s)
- Steffen Sum
- College of Veterinary Medicine, Department of Small Animal Medicine and Surgery, University of Georgia, Athens, GA 30602, USA
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Gastrointestinal neuromuscular pathology: guidelines for histological techniques and reporting on behalf of the Gastro 2009 International Working Group. Acta Neuropathol 2009; 118:271-301. [PMID: 19360428 DOI: 10.1007/s00401-009-0527-y] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Revised: 03/19/2009] [Accepted: 03/22/2009] [Indexed: 01/30/2023]
Abstract
The term gastrointestinal neuromuscular disease describes a clinically heterogeneous group of disorders of children and adults in which symptoms are presumed or proven to arise as a result of neuromuscular, including interstitial cell of Cajal, dysfunction. Such disorders commonly have impaired motor activity, i.e. slowed or obstructed transit with radiological evidence of transient or persistent visceral dilatation. Whilst sensorimotor abnormalities have been demonstrated by a variety of methods in these conditions, standards for histopathological reporting remain relatively neglected. Significant differences in methodologies and expertise continue to confound the reliable delineation of normality and specificity of particular pathological changes for disease. Such issues require urgent clarification to standardize acquisition and handling of tissue specimens, interpretation of findings and make informed decisions on risk-benefit of full-thickness tissue biopsy of bowel or other diagnostic procedures. Such information will also allow increased certainty of diagnosis, facilitating factual discussion between patients and caregivers, as well as giving prognostic and therapeutic information. The following report, produced by an international working group, using established consensus methodology, presents proposed guidelines on histological techniques and reporting for adult and paediatric gastrointestinal neuromuscular pathology. The report addresses the main areas of histopathological practice as confronted by the pathologist, including suction rectal biopsy and full-thickness tissue obtained with diagnostic or therapeutic intent. For each, indications, safe acquisition of tissue, histological techniques, reporting and referral recommendations are presented.
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Abudayyeh S, Hoffman J, El-Zimaity HT, Graham DY. Prospective, randomized, pathologist-blinded study of disposable alligator-jaw biopsy forceps for gastric mucosal biopsy. Dig Liver Dis 2009; 41:340-4. [PMID: 18799373 PMCID: PMC2838448 DOI: 10.1016/j.dld.2008.07.317] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Revised: 07/02/2008] [Accepted: 07/25/2008] [Indexed: 12/11/2022]
Abstract
BACKGROUND Endoscopic biopsy forceps differ in the size and shape of the biopsy cup and the presence or absence of a needle. METHODS We compared four different "large cup" forceps (three with needles) designed for 2.8mm biopsy channels. A gastric antral and corpus biopsy were obtained with each. Parameters examined included: weight (mg), length (mm), orientation (poor, good), intactness (1, 2, or 3 pieces), depth (superficial, above muscularis mucosae, included muscularis mucosae), crush artefact (yes, no), and overall adequacy (inadequate, suboptimal, adequate). RESULTS Twenty-four patients were enrolled (191 biopsies). The median length was approximately 5mm (range 1.1-8.2mm). Histologically inadequate specimens were present in 4% with the forceps without needle compared to 16% of those with needles (P=0.061) and there were significantly fewer specimens in three or more pieces than did the forceps with needles 2.1% vs. 12.6% (P<0.05). CONCLUSIONS Current alligator style forceps provide a high proportion of acceptable specimens with only minor differences between brands. Forceps from one source were least preferred by endoscopy assistants and had the highest rates of inadequate biopsies and biopsies with crush artefact. Forceps without needles provide histologically acceptable samples slightly more frequently than those with needles.
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Affiliation(s)
- S Abudayyeh
- Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA
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Elmunzer BJ, Higgins PDR, Kwon YM, Golembeski C, Greenson JK, Korsnes SJ, Elta GH. Jumbo forceps are superior to standard large-capacity forceps in obtaining diagnostically adequate inflammatory bowel disease surveillance biopsy specimens. Gastrointest Endosc 2008; 68:273-8; quiz 334, 336. [PMID: 18155204 DOI: 10.1016/j.gie.2007.11.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2007] [Accepted: 11/14/2007] [Indexed: 02/08/2023]
Abstract
BACKGROUND In inflammatory bowel disease (IBD) surveillance colonoscopy, an increased number of biopsy specimens correlates with a higher dysplasia detection rate. Larger biopsy specimens may also increase the diagnostic yield. OBJECTIVE To compare a new jumbo forceps with a standard large-capacity forceps in obtaining diagnostically adequate IBD surveillance biopsy specimens. DESIGN Prospective single-center study. PATIENTS AND METHODS Twenty-four patients who were undergoing an IBD surveillance colonoscopy were enrolled. As part of standard IBD surveillance, 8 paired biopsy specimens were obtained from the rectosigmoid by using the jumbo forceps and a standard large-capacity forceps. OUTCOME MEASUREMENTS Biopsy specimens were deemed adequate if they met all 3 of the following criteria: (1) length > or =3 mm, (2) penetration into the muscularis mucosa, and (3) < 20% crush artifact. RESULTS The proportion of adequate biopsy specimens obtained with the jumbo forceps was significantly higher than that obtained with the large-capacity control forceps (67% vs 48%, P < .0001). The average length of the biopsy specimen obtained with the jumbo forceps was 4.00 mm (95% CI, 3.81-4.20 mm) compared with 3.19 mm (95% CI, 2.99-3.38 mm) with the large-capacity (control) forceps. LIMITATIONS (1) No validated outcome measurement for the quality of GI biopsy specimens exists and (2) in this study, interobserver variability between pathologists was high. CONCLUSIONS The jumbo forceps was superior to a standard large-capacity forceps in obtaining diagnostically adequate IBD surveillance biopsy specimens. Because biopsy specimens obtained with the jumbo forceps were larger, the use of this forceps for IBD surveillance will allow the endoscopist to sample a larger colonic mucosal surface area, potentially resulting in an increased dysplasia detection rate.
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Affiliation(s)
- B Joseph Elmunzer
- Division of Gastroenterology Pathology, University of Michigan School of Medicine, Ann Arbor, Michigan 48109, USA
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Hookey LC, Hurlbut DJ, Day AG, Manley PN, Depew WT. One bite or two? A prospective trial comparing colonoscopy biopsy technique in patients with chronic ulcerative colitis. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2007; 21:164-8. [PMID: 17377645 PMCID: PMC2657684 DOI: 10.1155/2007/851830] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND STUDY AIMS Surveillance for mucosal dysplasia in patients with chronic ulcerative colitis requires numerous biopsies (often over 40). The aim of the present study was to determine if two biopsies could be obtained with jumbo forceps before removing them from the instrument (double biopsy technique), as opposed to one biopsy per pass, without sacrificing the histological quality of the biopsy material. METHODS Twelve patients with chronic ulcerative colitis underwent colonoscopy, and four-quadrant biopsies were obtained at 10 cm intervals. For biopsies at each interval, two quadrants were obtained using the double biopsy technique and the other two quadrants were obtained individually. Two pathologists blinded to the biopsy technique examined each biopsy for technical and diagnostic qualities. The primary outcome was the histological adequacy in the evaluation of dysplasia. RESULTS A total of 468 biopsies were obtained. A higher proportion of double-biopsy specimens were inadequate for dysplasia assessment compared with single-biopsy specimens (OR=2.78, 95% CI 1.37 to 5.59; P=0.005). In the double biopsy technique group, 14 samples were deemed inadequate due to actual tissue specimen loss, compared with eight samples in the single biopsy technique. However, when analysis was repeated using only the retrieved specimens, the double biopsy technique continued to be at higher risk of obtaining inadequate specimens (OR=14.5, 95% CI 2.1 to 98.7; P=0.006). CONCLUSIONS The results of the present study suggest that the double biopsy technique is vulnerable to specimen loss and reduced histological quality, and the adoption of this technique as an equivalent method for tissue sampling may be premature.
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Barkun A, Liu J, Carpenter S, Chotiprasidhi P, Chuttani R, Ginsberg G, Hussain N, Silverman W, Taitelbaum G, Petersen BT. Update on endoscopic tissue sampling devices. Gastrointest Endosc 2006; 63:741-5. [PMID: 16650530 DOI: 10.1016/j.gie.2006.02.041] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Abstract
AIM: To tattoo gastric mucosa with a novel medical device which could be used to monitor and follow-up gastric mucosal lesions.
METHODS: Combining endoscopic biopsy with sclerotherapy injection, we designed a new device that could perform biopsy and injection simultaneously. We performed endoscopies on a pig by using a novel endoscope tattoo biopsy forceps for 15 mo. At the same time, we used two-step method combining sclerotherapy injection needle with endoscopic biopsy. The acuity, inflammation and duration of endoscopy were compared between two methods.
RESULTS: Compared with the old two-step method, although the inflammation induced by our new device was similar, the duration of procedure was markedly decreased and the acuity of tattooing was better than the old two-step method. All characteristics of the novel device complied with national safety guidelines. Follow-up gastroscopy after 15 mo showed the stained site with injection of 1:100 0.5 mL of India ink was still markedly visible with little inflammatory reaction.
CONCLUSION: Endoscopic tattooing biopsy forceps can be widely used in monitoring precancerous lesions. Its safety and effectiveness has been established in animals.
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Affiliation(s)
- Jian-Min Si
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Hangzhou 310016, Zhejiang Province, China.
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25
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Abstract
Gastrointestinal biopsy is a potentially powerful tool, but it is easy to do it incorrectly. If clinicians are careless in performing or submitting biopsies, or if they blindly believe whatever the histopathology report says, they are abdicating their responsibility to the client and patient. Two comments seem most appropriate. First, the goal of endoscopy is not to be able to place the tip of an endoscope in a particular location; rather, the goal of endoscopy is to be able to access a particular location and then take a diagnostic specimen well enough that surgery can be avoided. Second, attention to detail is worth at least as much if not more than technology.
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Affiliation(s)
- Joanne Mansell
- Department of Veterinary Pathobiology, College of Veterinary Medicine, Texas A&M University, College Station, TX 77843-4467, USA
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Bourguignon C, Destrumelle AS, Koch S, Grumblat A, Carayon P, Chopard C, Woronoff-Lemsi MC. Disposable versus reusable biopsy forceps in GI endoscopy: a cost-minimization analysis. Gastrointest Endosc 2003; 58:226-9. [PMID: 12872090 DOI: 10.1067/mge.2003.341] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND The use of disposable biopsy forceps seems to be effective and safer than reusable biopsy forceps with respect to the risk of infection transmission. The results of cost analysis studies comparing reusable versus disposable biopsy forceps are conflicting. This study compared the cost of reusable versus disposable biopsy forceps. METHODS A cost-minimization analysis was carried out from the viewpoint of a hospital. Direct costs were included. The study design was retrospective. For reusable biopsy forceps, the evaluation of costs included purchase prices, cleaning (chemicals, equipment, technician time), and a fee for sterilization in a centralized facility. The cost evaluation for disposable biopsy forceps included acquisition and destruction costs. Costs were expressed in United States dollars. RESULTS The mean number of uses was approximately 90 per reusable forceps. The cost per use of reusable biopsy forceps was 6.84 US dollars (acquisition 3.59 US dollars, cleaning 2.28 US dollars, centralized sterilization fee 0.97 US dollars). The cost per use of disposable biopsy forceps varied from 10.72 US dollars to 15.63 US dollars. Additional cost per use of disposable biopsy forceps ranged from 3.88 US dollars to 8.79 US dollars. CONCLUSIONS From a strictly economic point of view, the use of reusable biopsy forceps is advantageous. However, additional factors should be considered. It would be essential to take into account the potential risk of infectious disease transmission related to the use of both types of forceps, which remains uncharacterized.
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Affiliation(s)
- Céline Bourguignon
- Central Supply of Medical Devices, Department of Gastrointestinal Endoscopy, Besançon University Hospital, Besançon Cx, France
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Padda S, Shah I, Ramirez FC. Adequacy of mucosal sampling with the "two-bite" forceps technique: a prospective, randomized, blinded study. Gastrointest Endosc 2003; 57:170-3. [PMID: 12556778 DOI: 10.1067/mge.2003.75] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Although the "two-bite" technique (obtaining 2 mucosal biopsy specimens with a single passage of the forceps) is used routinely, the adequacy of the second biopsy for histopathologic examination has not been evaluated. Our hypothesis was that the second sample will be inadequate for this purpose. The aim of this study was to prospectively assess the adequacy of mucosal biopsy specimens obtained with 3 different types of forceps with the two-bite technique. METHODS Patients undergoing diagnostic EGD were prospectively enrolled in the study. In each patient, mucosal biopsy specimens were obtained as follows: 4 specimens with the two-bite technique in 2 separate passages of the forceps (one from the esophagus followed by one from the stomach, and one from the stomach followed by one from the esophagus, the order being chosen randomly) and 2 single-bite specimens from the same anatomic locations (esophagus and stomach). Each patient underwent the same biopsy sampling sequence with 3 different forceps. An experienced pathologist blinded to the sequence and technique of obtaining the samples and the forceps used evaluated the specimens for number submitted, integrity, and adequacy for histopathologic diagnosis and depth of the sample as assessed by the presence or absence of muscularis mucosae. RESULTS A total of 288 mucosal samples were obtained from 16 patients. Of these, 192 were taken by using the two-bite technique. Thirty-five (18.2%) samples were missing when the two-bite technique was used compared with only 2 (2.1%) when the single bite technique was used (p < 0.05). Irrespective of the location from which the first mucosal sample was taken, a significantly greater number of first samples were lost (25%) compared with second samples (11.5%) (p < 0.05). The forceps without a spike was associated with significantly more missing samples than the spiked forceps (28.1% vs. 13.3%; p = 0.01). At histopathologic evaluation, there were no significant differences between first and second samples nor differences between samples taken with the two-bite and the single-bite techniques with regard to adequacy, integrity, and depth. With respect to histopathologic evaluation, there were no differences among the 3 types of forceps used in the study. CONCLUSIONS Although the second mucosal sample obtained with the two-bite technique is adequate for histopathologic purposes, there is a significant risk of losing samples (the first one in particular) with this technique, and thus an increase in the probability of sampling error. This may be particularly true for forceps without a spike.
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Affiliation(s)
- Sukhdeep Padda
- Gastroenterology Section, Department of Medicine, Carl T. Hayden Veterans Affairs Medical Center, Phoenix, Arizona 85012, USA
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Abstract
Benign esophageal tumors are uncommon. Flexible fiberoptic esophagoscopy (esophagoscopy) has improved detection but is ineffective in classification of extramucosal tumors. Endoscopic esophageal ultrasound (EUS) is vital in diagnosis. Small lesions that have either a homogeneous anechoic, intermediate, or hyperechoic pattern are almost exclusively benign. These findings, plus the determination of the layer of origin within the esophageal wall, permit precise and accurate noninvasive diagnosis. The diagnosis of a benign esophageal tumor by esophagoscopy and EUS in an asymptomatic patient requires, at most, surveillance but no therapy.
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Affiliation(s)
- Thomas W Rice
- Division of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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Schafer TW, Hollis-Perry KM, Mondragon RM, Brann OS. An observer-blinded, prospective, randomized comparison of forceps for endoscopic esophageal biopsy. Gastrointest Endosc 2002; 55:192-6. [PMID: 11818921 DOI: 10.1067/mge.2002.121225] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND The designs of 2 new biopsy forceps attempt to address the difficulty of obtaining esophageal biopsy specimens. The angled design is a modified version of currently used straight forceps. The lateral cup forceps has a straight shaft with a bullet-shaped cuffing head for a tangential approach. METHODS Seventy-five patients were enrolled in a prospective study in which 3 different forceps were compared in random order: a reusable straight-shaft spiked forceps, a reusable angled-shaft spiked forceps, and a disposable lateral cup forceps. Two biopsy specimens were obtained with each device per patient. Two pathologists, blinded as to forceps used, graded the tissue samples for size, histologic depth, shear artifact, crush artifact, and adequacy for diagnosis. Data were compared by using multivariate analysis of variance and Scheffé's method. RESULTS Analysis of variance showed overall differences in specimen size, histologic depth score, and diagnostic adequacy (p < 0.001). There was no significant difference for crush (p = 0.459) or shear artifacts (p = 0.243). Pair-wise comparisons demonstrated that tissue samples obtained with the straight forceps were larger (p = 0.020) and deeper (p = 0.040) than the angled forceps. These 2 designs were similar in terms of diagnostic adequacy. Biopsy specimens obtained with the straight forceps were larger (p < 0.001) and deeper (p < 0.001) than those obtained with the lateral cup forceps. Both the straight and angled forceps were superior to the lateral cup forceps in terms of diagnostic adequacy (p = 0.020, p = 0.008, respectively). CONCLUSIONS The reusable straight-shaft spiked forceps provides larger and deeper esophageal biopsy specimens than either the angled or lateral cup forceps. The angled forceps provides specimens of similar adequacy for diagnosis compared with the straight forceps. The lateral cup forceps should not be used in the esophagus.
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Affiliation(s)
- Theodore W Schafer
- Department of Internal Medicine, Division of Gastroenterology, Naval Medical Center, San Diego, California 92134-1005, USA
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Padda S, Ramirez FC. Accuracy in the diagnosis of short-segment Barrett's esophagus: the role of endoscopic experience. Gastrointest Endosc 2001; 54:605-8. [PMID: 11677477 DOI: 10.1067/mge.2001.118714] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND The diagnosis of Barrett's esophagus is based on histologic demonstration of specialized intestinal metaplasia. Experience may be important in the endoscopic recognition of Barrett's esophagus, including in regard to appropriate procurement of biopsy specimens. The aim of this study was to assess factors that may influence accuracy in the diagnosis of short-segment Barrett's esophagus (SSB). METHODS Endoscopy reports pertaining to procedures performed over a 1-year period that included esophageal biopsies because of suspected intestinal metaplasia were reviewed. Barrett's epithelium involving less than 2 cm of the distal esophagus was considered SSB; greater than 2 cm was considered long-segment (LSB). Endoscopists were regarded as "more experienced" if they had completed training more than 5 years earlier and "less experienced" if the time elapsed since the completion of training was less than 5 years. RESULTS More and less experienced endoscopists both obtained esophageal biopsy specimens because of suspected Barrett's esophagus at the same rate (14%). Length of suspected Barrett's epithelium was not predicted by symptoms or demographic data. Endoscopically, patients with SSB had significantly fewer (64.2% vs. 90.8%) and smaller (2.9 +/- 0.1 vs. 3.5 +/- 0.2 cm) hiatal hernias compared with those with LSB (p < 0.05). Suspected SSB was histologically confirmed in 38.4% (True SSB), whereas LSB was confirmed in 75% (True SSB) (p < 0.05). More experienced endoscopists were significantly more likely to obtain histologic confirmation of SSB than less experienced endoscopists (48.6% vs. 29.5%; p = 0.02, nominal significance from univariate hypothesis testing; correction for multiple testing of data removed significance at the p < 0.05 level; OR = 2.26). CONCLUSION With greater experience, an endoscopist is more likely to diagnose SSB. This may be due to more accurate procurement of adequate tissue samples, which thereby results in a greater yield of histopathologic diagnoses.
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Affiliation(s)
- S Padda
- Department of Medicine, Gastroenterology Section, Carl T. Hayden Veterans Administration Medical Center, Phoenix, Arizona 85012, USA
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Fantin AC, Neuweiler J, Binek JS, Suter WR, Meyenberger C. Diagnostic quality of biopsy specimens: comparison between a conventional biopsy forceps and multibite forceps. Gastrointest Endosc 2001; 54:600-4. [PMID: 11677476 DOI: 10.1067/mge.2001.118945] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND The endoscopic biopsy is a prerequisite for histopathologic diagnosis. Various types of forceps are used to obtain tissue specimens. The aim of this study was to assess and compare the diagnostic quality of biopsy specimens obtained with a conventional forceps and a Multibite forceps. METHODS In a prospective, partially blinded, and randomized trial that included 250 patients referred for diagnostic upper and/or lower endoscopy, 510 biopsy specimens obtained with the Multibite forceps were compared with 520 specimens obtained with a conventional forceps. An experienced, blinded pathologist evaluated the specimens for diameter, depth of specimen, artifacts, anatomic orientation, vitality, general histologic quality, and diagnostic quality. Statistical analysis was performed by using the Fisher exact test. A p value of < 0.05 was regarded as significant. RESULTS There were no statistically significant differences between the specimens obtained with the 2 forceps. The p values for the evaluated parameters were as follows: diameter 0.45, depth of specimen 0.56, artifacts 1.0, pathoanatomic orientation 0.40, vitality 0.45, and histologic diagnostic quality 0.53. CONCLUSION The quality of biopsy specimens obtained with the Multibite forceps is comparable with that of specimens taken with a conventional forceps. Use of the Multibite forceps saves time in that 4 specimens can be obtained in 1 pass in situations in which a large number of specimens are needed or when the potential for transmission of infection is of concern.
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Affiliation(s)
- A C Fantin
- Department of Internal Medicine, Division of Gastroenterology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Willard MD, Lovering SL, Cohen ND, Weeks BR. Quality of tissue specimens obtained endoscopically from the duodenum of dogs and cats. J Am Vet Med Assoc 2001; 219:474-9. [PMID: 11518173 DOI: 10.2460/javma.2001.219.474] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate quality of duodenal tissue specimens obtained endoscopically from dogs and cats and submitted to 1 of 2 diagnostic laboratories for evaluation. DESIGN Case series. SAMPLE POPULATION Slides from 50 consecutive canine and 50 consecutive feline endoscopically obtained duodenal tissue specimens submitted to laboratory 1 and 49 consecutive canine and 46 consecutive feline specimens submitted to laboratory 2. PROCEDURE Slides were examined independently by 3 investigators, and each tissue piece on each slide was classified as clearly inadequate, questionable, or clearly adequate on the basis of 4 criteria. An overall score was then assigned to the slide. RESULTS Slides from laboratory 1 were more likely to be scored as clearly adequate and less likely to be scored as clearly inadequate than slides from laboratory 2. Clearly adequate slides from laboratory 1 had a higher number of clearly adequate pieces of tissue than did clearly adequate slides from laboratory 2. Slides scored as clearly adequate had a higher number of individual tissue pieces than did slides scored as clearly inadequate. CONCLUSIONS AND CLINICAL RELEVANCE Results suggest that the quality of endoscopically obtained duodenal tissue specimens submitted to laboratories can vary, possibly because of differences in experience of individuals collecting biopsy specimens. Results suggest that at least 8 individual tissue pieces should be submitted when performing endoscopic biopsy of the duodenum in dogs and cats.
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Affiliation(s)
- M D Willard
- Department of Small Animal Medicine, College of Veterinary Medicine, Texas A&M University, College Station 77843, USA
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Abstract
Colonoscopy and proctoscopy are primarily performed on dogs and cats with signs of chronic large bowel or rectal disease, and ileoscopy is typically performed in patients with signs of either large or small bowel disease. These techniques should not be used indiscriminately but only on animals that have a reasonable chance to benefit from their use. Even then, the techniques must be performed carefully so that the results are meaningful instead of misleading. We first consider what does and what does not constitute a reasonable indication for endoscopic examination of the lower intestines. After that, we turn to the specific techniques involved.
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Affiliation(s)
- M D Willard
- Department of Small Animal Medicine and Surgery, Texas A & M University, College of Veterinary Medicine, College Station, Texas, USA.
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