Obtaining biopsies during endoscopic investigation of the gastrointestinal tract for selected inflammatory disorders

Česká verzia

Authors: O. Daum ¹; Z. Beneš ²; M. Michal ¹
Authors place of work: Bioptická laboratoř s. r. o., Plzeň a Šiklův ústav patologie, LF Plzeň, UK Praha ¹; II. interní klinika, Fakultní Thomayerova nemocnice, Praha ²
Published in the journal: Gastroent Hepatol 2011; 65(2): 84-89
Category: Clinical and Experimental Gastroenterology: Review Article

Summary

Obtaining mucosal biopsies has become a standard part of endoscopic investigations of the gastrointestinal tract. Although targeting biopsies of tumoriform (neoplastic) lesions does not usually constitute a difficult task, investigating inflammatory disorders may necessitate more extensive tissue harvesting due to the discontinuous or even patchy distribution of morphological changes, topical differences in the intensity of inflammatory changes and finally, in attempts to detect early phases of inflammation-associated tumour development. Furthermore, even if clinical guidelines exist (e.g. Barrett’s oesophagus or chronic gastritis), they are usually not followed in practice, especially regarding the amount of retrieved tissue or number of sites investigated by biopsy. However, an inappropriate number of tissue samples may paradoxically cause harm to the patient due to the necessity of repeating the biopsy.

Key words:
biopsy – Barrett’s oesophagus – celiac disease – endoscopy – eosinophilic esophagitis – gastritis – microscopic colitis – reflux esophagitis – inflammatory bowel disease

Zdroje

1. Benes Z, Daum O, Puskarova G et al. Význam endoskopické cytoskopie u vyšetření trávicího traktu. Vnitř Lék 2007; 53(11): 1215–1219.

2. Inoue H, Kudo SE, Shiokawa A. Novel endoscopic imaging techniques toward in vivo observation of living cancer cells in the gastrointestinal tract. Dig Dis 2004; 22(4): 334–337.

3. Yantiss RK, Odze RD. Optimal approach to obtaining mucosal biopsies for assessment of inflammatory disorders of the gastrointestinal tract. Am J Gastroenterol 2009; 104(3): 774–783.

4. Furuta GT, Liacouras CA, Collins MH et al. Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology 2007; 133(4): 1342–1363.

5. Liacouras CA, Spergel JM, Ruchelli E et al. Eosinophilic esophagitis: a 10-year experience in 381 children. Clin Gastroenterol Hepatol 2005; 3(12): 1198–1206.

6. Chandrasoma PT, Der R, Ma Y et al. Histology of the gastroesophageal junction: an autopsy study. Am J Surg Pathol 2000; 24(3): 402–409.

7. Chandrasoma PT, Lokuhetty DM, Demeester TR et al. Definition of histopathologic changes in gastroesophageal reflux disease. Am J Surg Pathol 2000; 24(3): 344–351.

8. Chandrasoma PT, Der R, Dalton P et al. Distribution and significance of epithelial types in columnar-lined esophagus. Am J Surg Pathol 2001; 25(9): 1188–1193.

9. Chandrasoma P. Histopathology of the gastroesophageal junction: a study on 36 operation specimens. Am J Surg Pathol 2003; 27(2): 277–278.

10. Chandrasoma P. Cardiac mucosal changes in a pediatric population. Am J Surg Pathol 2003; 27(2): 274–275.

11. Chandrasoma PT, Der R, Ma Y et al. Histologic classification of patients based on mapping biopsies of the gastroesophageal junction. Am J Surg Pathol 2003; 27(7): 929–936.

12. Chandrasoma P. Controversies of the cardiac mucosa and Barrett‘s oesophagus. Histopathology 2005; 46(4): 361–373.

13. Chandrasoma P, Makarewicz K, Wickramasinghe K et al. A proposal for a new validated histological definition of the gastroesophageal junction. Hum Pathol 2006; 37(1): 40–47.

14. Chandrasoma P, Wickramasinghe K, Ma Y et al. Adenocarcinomas of the distal esophagus and „gastric cardia“ are predominantly esophageal carcinomas. Am J Surg Pathol 2007; 31(4): 569–575.

15. Lenglinger J, Ringhofer C, Eisler M et al. Histopathology of columnar-lined esophagus in patients with gastroesophageal reflux disease. Wien Klin Wochenschr 2007; 119(13–14): 405–411.

16. Chandrasoma P, Wijetunge S, Demeester SR et al. The histologic squamo-oxyntic gap: an accurate and reproducible diagnostic marker of gastroesophageal reflux disease. Am J Surg Pathol 2010; 34(11): 1574–1581.

17. Wijetunge S, Ma Y, DeMeester S et al. Association of adenocarcinomas of the distal esophagus, „gastroesophageal junction“ and „gastric cardia“ with gastric pathology. Am J Surg Pathol 2010; 34(10): 1521–1527.

18. Chandrasoma P. Four directed biopsies are better than eight random biopsies to find intestinal metaplasia in columnar lined esophagus. Am J Gastroenterol 2007; 102(10): 2352–2353.

19. Canto MI, Setrakian S, Willis J et al. Methylene blue-directed biopsies improve detection of intestinal metaplasia and dysplasia in Barrett‘s esophagus. Gastrointest Endosc 2000; 51(5): 560–568.

20. Kumagai Y, Monma K, Kawada K. Magnifying chromoendoscopy of the esophagus: in-vivo pathological diagnosis using an endocytoscopy system. Endoscopy 2004; 36(7): 590–594.

21. Kumagai Y, Kawada K, Yamazaki S et al. Endocytoscopic observation for esophageal squamous cell carcinoma: can biopsy histology be omitted? Dis Esophagus 2009; 22(6): 505–512.

22. Kumagai Y, Kawada K, Yamazaki S et al. Prospective replacement of magnifying endoscopy by a newly developed endocytoscope, the ‚GIF-Y0002‘. Dis Esophagus 2010; 23(8): 627–632.

23. Dixon MF, Genta RM, Yardley JH et al. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol 1996; 20(10): 1161–1181.

24. Eriksson NK, Farkkila MA, Voutilainen ME et al. The clinical value of taking routine biopsies from the incisura angularis during gastroscopy. Endoscopy 2005; 37(6): 532–536.

25. Meijer JW, Wahab PJ, Mulder CJ. Small intestinal biopsies in celiac disease: duodenal or jejunal? Virchows Arch 2003; 442(2): 124–128.

26. Lukáš Z. Histopatologie a diferenciální diagnostika celiakální sprue. Cesk Patol 2004; 40(1): 3–6.

27. Chlumská A, Beneš Z, Mukenšnabl P. Celiakie – histologické nálezy v duodenální sliznici a jejich diagnostický význam. Kongresové noviny (IV. Kongres České gastroenterologické společnosti ČLS JEP) 2009: 8.

28. Ravelli A, Bolognini S, Gambarotti M et al. Variability of histologic lesions in relation to biopsy site in gluten-sensitive enteropathy. Am J Gastroenterol 2005; 100(1): 177–185.

29. Hopper AD, Cross SS, Sanders DS. Patchy villous atrophy in adult patients with suspected gluten-sensitive enteropathy: is a multiple duodenal biopsy strategy appropriate? Endoscopy 2008; 40(3): 219–224.

30. Bonamico M, Mariani P, Thanasi E et al. Patchy villous atrophy of the duodenum in childhood celiac disease. J Pediatr Gastroenterol Nutr 2004; 38(2): 204–207.

31. Pinczowski D, Ekbom A, Baron J et al. Risk factors for colorectal cancer in patients with ulcerative colitis: a case-control study. Gastroenterology 1994; 107(1): 117–120.

32. Jess T, Loftus EV Jr., Velayos FS et al. Risk of intestinal cancer in inflammatory bowel disease: a population-based study from Olmsted county, Minnesota. Gastroenterology 2006; 130(4): 1039–1046.

33. Biancone L, Michetti P, Travis S et al. European evidence-based consensus on the management of ulcerative colitis: special situations. J Crohns Colitis 2008; 2(1): 63–92.

34. Kiesslich R, Galle PR, Neurath MF. Endoscopic surveillance in ulcerative colitis: smart biopsies do it better. Gastroenterology 2007; 133(3): 742–745.

35. Kiesslich R, Goetz M, Lammersdorf K et al. Chromoscopy-guided endomicroscopy increases the diagnostic yield of intraepithelial neoplasia in ulcerative colitis. Gastroenterology 2007; 132(3): 874–882.

36. Lazenby AJ. Collagenous and lymphocytic colitis. Semin Diagn Pathol 2005; 22: 295–300.

37. Lazenby AJ, Yardley JH, Giardiello FM et al. Lymphocytic („microscopic“) colitis: a comparative histopathologic study with particular reference to collagenous colitis. Hum Pathol 1989; 20(1): 18–28.

38. Thijs WJ, van Baarlen J, Kleibeuker JH et al. Microscopic colitis: prevalence and distribution throughout the colon in patients with chronic diarrhoea. Neth J Med 2005; 63(4): 137–140.

39. Surawicz CM. Collating collagenous colitis cases. Am J Gastroenterol 2000; 95(1): 307–308.

40. Tanaka M, Mazzoleni G, Riddell RH. Distribution of collagenous colitis: utility of flexible sigmoidoscopy. Gut 1992; 33(1): 65–70.