Diagnostic yield of tissue sampling using a bite-on-bite technique for incidental subepithelial lesions.
OBJECTIVE
Techniques for endoscopic evaluation of gastrointestinal subepithelial lesions include conventional endoscopy, jumbo biopsy, endoscopic ultrasonogrphy (EUS), EUS-guided fine needle aspiration, and endoscopic submucosal resection. However, these procedures have many limitations, such as low diagnostic yields and high complication rates. We therefore evaluated the diagnostic yield for tissue sampling of incidental subepithelial lesions using the bite-on-bite technique.


METHODS
One hundred and forty subepithelial lesions were found in 129 patients during conventional diagnostic esophagogastroduodenoscopy by one examiner from October 2003 to November 2004. Bite-on-bite biopsies with conventional-sized forceps were taken from 36 patients having 37 lesions that did not appear to be hypervascular or to have a thick overlying epithelium. Two to eight bites were performed to obtain submucosal tissue for one lesion.


RESULTS
The bite-on-bite technique was diagnostic in 14 of the 37 lesions (38%). Blood oozing for more than 30 seconds occurred in five cases, but was easily controlled by epinephrine injection (2 cases) or hemoclip (3 cases). The diagnostic yield tended to be higher in the esophagus than in the stomach and duodenum (54% vs. 28%, p=0.109).


CONCLUSIONS
The bite-on-bite technique for subepithelial lesions is an effective and safe method in selected cases. This technique may be useful for incidental subepithelial lesions, especially those of the esophagus, except for ones with a high risk of bleeding or thick overlying epithelium.
Ji
Jeong-Seon
JS
Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Lee
Bo-In
BI
Choi
Kyu-Yong
KY
Kim
Byung-Wook
BW
Choi
Hwang
H
Huh
Min
M
Chung
Woo-Chul
WC
Chae
Hiun-Suk
HS
Chung
In-Sik
IS
D000328:Adult; D000368:Aged; D001706:Biopsy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004386:Duodenum / Q000473:pathology*; D016145:Endoscopy, Digestive System / Q000009:adverse effects; D004947:Esophagus / Q000473:pathology*; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control; D006489:Hemostatic Techniques; D006801:Humans; D033162:Incidental Findings; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013270:Stomach / Q000473:pathology*; D013525:Surgical Instruments