title: A New Method for Endoscopic Sampling of Submucosal Tissue in the Gastrointestinal Tract: A Comparison of the Biopsy Forceps and a New Drill Instrument.
abstract: Background Sampling of submucosal lesions in the gastrointestinal tract through a flexible endoscope is a well-recognized clinical problem. One technique often used is endoscopic ultrasound-guided fine-needle aspiration, but it does not provide solid tissue biopsies with preserved architecture for histopathological evaluation. To obtain solid tissue biopsies from submucosal lesions, we have constructed a new endoscopic biopsy tool and compared it in a crossover study with the standard double cupped forceps. Methods Ten patients with endoscopically verified submucosal lesions were sampled. The endoscopist selected the position for the biopsies and used the instrument selected by randomization. After a biopsy was harvested, the endoscopist chose the next site for a biopsy and again used the instrument picked by randomization. A total of 6 biopsies, 3 with the forceps and 3 with the drill instrument, were collected in every patient. Results The drill instrument resulted in larger total size biopsies (mm2; Mann-Whitney U test, P = .048) and larger submucosal part (%) of the biopsies (Mann-Whitney U test, P = .003) than the forceps. Two patients were observed because of chest pain and suspicion of bleeding in 24 hours. No therapeutic measures were necessary to be taken. Conclusion The new drill instrument for flexible endoscopy can safely deliver submucosal tissue samples from submucosal lesions in the upper gastrointestinal tract.
authors.affiliation: Skåne University Hospital, Lund, Sweden charles.walther@med.lu.se.
authors.forename: Charles
authors.initials: C
authors.lastname: Walther
authors.affiliation: Skåne University Hospital, Lund, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Jeremiasen
authors.affiliation: Skåne University Hospital, Lund, Sweden.
authors.forename: Pehr
authors.initials: P
authors.lastname: Rissler
authors.affiliation: Skåne University Hospital, Lund, Sweden.
authors.forename: Jan L M
authors.initials: JL
authors.lastname: Johansson
authors.affiliation: Skåne University Hospital, Lund, Sweden.
authors.forename: Marie S
authors.initials: MS
authors.lastname: Larsson
authors.affiliation: Skåne University Hospital, Lund, Sweden.
authors.forename: Bruno S C S
authors.initials: BS
authors.lastname: Walther
mesh_terms: D000368:Aged; D001706:Biopsy / Q000295:instrumentation* / Q000379:methods; D000069916:Endoscopic Mucosal Resection / Q000295:instrumentation* / Q000379:methods; D019160:Endosonography / Q000379:methods*; D004867:Equipment Design; D004869:Equipment Safety; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology; D005773:Gastroscopy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009339:Needles; D018709:Statistics, Nonparametric; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D013525:Surgical Instruments
keywords: esophageal surgery; flexible endoscopy; interventional endoscopy