Evaluation of the New Giant-biopsy Forceps in the Diagnosis of Mucosal and Submucosal Gastric Lesions

Abstract

In order to improve the diagnosis of gastric disorders on the basis of biopsy material, we devised larger biopsy forceps (5 mm X 2.5 mm in inside dimensions) which fit into the newer fibergastroscope, GIF-1T (Olympus). Samples from 116 cases yielded 276 specimens; 179 specimens (64.8%) showed the full-thickness of the mucosa with muscularis mucosae, and approximately one-third of the total specimens included a considerable amount of submucosal tissue, but none of them contained parts of muscularis propria. In 4 out of 36 gastric carcinoma cases there was inconsistency between endoscopic and histological recognition of the proximal border of carcinomatous infiltration. Differentiation between adenoma and IIa, and benign and malignant lymphoma were more feasible with our forceps. No complications apart from minor bleeding were seen.

Diagnostic Yield of Tissue Sampling Using a Bite-On-Bite Technique for Incidental Subepithelial Lesions

“…Although traditionally used as a first-line diagnostic procedure for subepithelial lesions, endoscopic biopsy sampling with conventional-sized forceps is frequently non-diagnostic, primarily because of its limited depth of penetration. In fact, less than one-third of forceps biopsies include a significant amount of submucosae [3]. …”

“…Endoscopic biopsies with forceps rarely provide a diagnosis because lesions in the submucosa are beyond the reach of conventional-sized forceps [3,4]. For this reason, jumbo biopsy, EUS-guided fine needle aspiration (EUS-FNA), and endoscopic submucosal resection (ESMR) have been attempted.…”

Bioptic techniques in flexible endoscopy

“…Also, when the endoscopic suspicion of submucosal gastric disease occurs, the suspicion can be incorrectly dismissed if bi- opsy specimens are without pathology. The rate of successful biopsies in this context is low, varying between 30 and 40% [7,3]. In the present study we have systematically investigated three common different bioptic approaches in an experimental model.…”

Subepithelial mass lesions in the upper gastrointestinal tract

“…Kaneko et al . experienced no complications apart from minor bleeding in 116 cases 32 while when Hunt et al . used five double passes (10 bites) in 36 procedures, there was one complication of bleeding which required hospitalization but not transfusion 31 .…”

“…In one study the diagnostic yield for 3rd‐layer lesions using stacked ‘jumbo’ forceps biopsy (‘bite on bite’) was 42% using 10 bites compared with 89% for endoscopic mucosal–submucosal resection 31 . Complications from bite‐on‐bite jumbo forceps biopsies are uncommon; however, this is reflected by a low diagnostic yield with only one‐third of forceps biopsies containing a significant amount of submucosa 32 . Kaneko et al .…”