Histologic Evaluation of Endoscopic Versus Suction Biopsies of Small Intestinal Mucosae in Children with and Without Celiac Disease

Abstract

Biopsies obtained by suction are of better quality than those obtained by endoscopy. If endoscopy is preferred for technical reasons, the following conditions should be observed: the patients should be aged over 2 years, and a minimum of four biopsies should be obtained with forceps of a diameter greater than 2 mm. Adequate histologic criteria for diagnosis should include at least one full-thickness mucosal specimen more than 3 mm in length, vertically oriented, and not fragmented. In children under age 2, duodenal or jejunal capsule biopsies are preferred, since the specimens are usually larger and less fragmented. Endoscopy is technically more difficult in the very young patient.

Numerical Fidelity of Endoscopic Biopsy Fragments in the Processing Sequence of a University Surgical Pathology Laboratory

“…3,5,[9][10] For endoscopic biopsies of the otolaryngic and gastrointestinal region, the primary focus has been on differences in tissue fragmentation, based on the type of endoscopic biopsy obtained, particularly suction versus endoscopic forceps biopsies. 4,[6][7][8]11 Interestingly, in these studies squashing and fragmentation of such mucosal biopsies were noted in 25% to 83.3% of biopsies. 4,6 In these instances, fragmentation was defined histologically rather than grossly, as done in our study, which, to our knowledge, is the first that actually looks at the results of tissue handling from receipt in the gross processing room to the generation of a glass slide.…”

“…4,[6][7][8]11 Interestingly, in these studies squashing and fragmentation of such mucosal biopsies were noted in 25% to 83.3% of biopsies. 4,6 In these instances, fragmentation was defined histologically rather than grossly, as done in our study, which, to our knowledge, is the first that actually looks at the results of tissue handling from receipt in the gross processing room to the generation of a glass slide. The results of this study were surprising to us.…”

“…[3][4][5][6][7][8][9][10][11] In the assessment of liver and prostatic needle biopsies, tissue fragmentation has been noted particularly in prostate samples for which calculation of the number of cores affected by prostatic carcinoma has been recommended. 3,5,[9][10] For endoscopic biopsies of the otolaryngic and gastrointestinal region, the primary focus has been on differences in tissue fragmentation, based on the type of endoscopic biopsy obtained, particularly suction versus endoscopic forceps biopsies.…”

Assessment of the Diagnostic Value of Duodenal Bulb Histology in Patients With Celiac Disease, Using Multiple Biopsy Sites

“…Although biopsies were originally obtained by Crosby or Watson suction capsule from the distal duodenum, duodeno-jejunal junction (ligament of Treitz), or proximal jejunum under fluoroscopic control, 10 over the last few years endoscopy has become more and more widely used to take biopsies in patients with suspected CD, essentially because endoscopy has the major advantages of quicker procedure time, no x-ray exposure, direct visualization of the duodenum, and the ability to collect many biopsy samples, thus reducing the risk of failure and false negative findings. [11][12][13][14] The proximal jejunum and distal duodenum are commonly considered the best sites for the detection of subtotal/total VA in CD. 11,12,15 In a few adult patients with CD, however, VA can be patchy-that is, areas with subtotal/total VA may occur in proximity to areas with mild or partial VA and possibly also areas with normal (type 0) histology.…”

The frequency of histologic lesion variability of the duodenal mucosa in children with celiac disease

“…All biopsies were analyzed by an experienced pathologist, who was blinded about the site of biopsies at the time of histologic evaluation. The histologic adequacy of samples was assessed as that by Branski et al and by Gottrand et al [8,9] All histologic parameters were evaluated and histologic lesions were classifi ed according to the Oberhuber classifi cation [10] with modifi cation proposed by our group: [11,12] Type 0 is a normal mucosa with <25 IEL/100 epithelial cells (EC).…”