Percutaneous endoscopically assisted transenteric full-thickness gastric biopsy: initial experience in humans

Andrews, Christopher N.; Mintchev, Paul; Neshev, Emil; Fraser, Hughie F.; Storr, Martin; Bathe, Oliver F.; Urbanski, Stefan J.

doi:10.1016/j.gie.2010.12.037

Cited by 13 publications

(4 citation statements)

References 17 publications

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“…However, the techniques were limited by lack of adequate sample size and/or safety issues. Percutaneous endoscopically assisted transenteric full-thickness biopsy using a 14-gauge needle for assessing histopathological abnormalities in GINMD showed abnormalities in 44% of patients 15 . Recently an EUS-guided fine-needle aspiration of the gastric antrum MP using a 19 gauge core-needle was shown to be safe with adequate tissue for histologic assessment of myenteric plexus in 54.5% and ICC in 81% of patients 16,17 .…”

Section: Discussionmentioning

confidence: 98%

Innovative gastric endoscopic muscle biopsy to identify all cell types, including myenteric neurons and interstitial cells of Cajal in patients with idiopathic gastroparesis: a feasibility study (with video)

Rajan

Gostout

Song

et al. 2016

Gastrointestinal Endoscopy

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Background and Aims The pathophysiology of some gastrointestinal neuromuscular diseases (GINMD) remains largely unknown. This is in part due to the inability to obtain ample deep gastric wall biopsies that include the intermuscular layer of the muscularis propria (MP) to evaluate the enteric nervous system, interstitial cells of Cajal (ICC) and related cells. We report on a novel technique for gastric endoscopic muscle biopsy (gEMB). Methods Patients with idiopathic gastroparesis were prospectively enrolled in a feasibility study using a novel “no hole” gEMB. Main outcome measures were technical success, adverse events and histological confirmation of the intermuscular layer, including myenteric neurons and ICC. The gEMB was a double resection clip–assist technique. A site was identified on the anterior wall of the gastric body as recommended by the International Working Group on histological techniques. Endoscopic mucosal resection was performed to unroof and expose the underlying MP. The exposed MP was then retracted into the cap of an over-the-scope clip. The clip was deployed and the pseudopolyp of MP created was resected. This resulted in a “nohole” gEMB. Results Three patients with idiopathic gastroparesis underwent gEMB. Patients had severe delayed gastric emptying with a mean of 49 ± 16.8% of retained gastric contents at 4 hours. They had no history of gastric or small-bowel surgery, and did not use steroids or other immunosuppressive drugs. The gEMB procedure was successfully performed with no procedural adverse events. Postprocedure abdominal pain was controlled with nonsteroidal anti-inflammatory agents and opioid analgesics. Mean length of resected MP was 10.3 ± 1.5 mm. Mean procedure time was 25.7 ± 6 minutes. Tissue samples on hematoxylin and eosin (H&E) stain confirmed presence of both inner circular and outer longitudinal muscle as well as the intermuscular layer. H&E stain showed reduced myenteric ganglia in 1 patient. In 2 patients, specialized immunohistochemistry was performed, which showed marked decrease in myenteric neurons as delineated by an antibody to Protein Gene Product (PGP) 9.5 and severe decrease in ICC across the muscle layers. At 1 month follow-up, upper endoscopy showed a well-healed scar in 2 patients and minimal ulceration with retained clip in 1 patient. CT abdomen confirmed the integrity of the gastric wall in all patients. Due to lack of an immune infiltrate in the resected samples, patients were not considered suitable for immunosuppressive or steroid therapy. Conclusions gEMB is feasible and easy to perform, with acquisition of tissue close to surgical samples to identify myenteric ganglia, ICC and multiple cell types. The ability to perform gEMB represents a paradigm shift in endoscopic tissue diagnosis of gastric neuromuscular pathologies.

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Section: Discussionmentioning

confidence: 98%

Innovative gastric endoscopic muscle biopsy to identify all cell types, including myenteric neurons and interstitial cells of Cajal in patients with idiopathic gastroparesis: a feasibility study (with video)

Rajan

Gostout

Song

et al. 2016

Gastrointestinal Endoscopy

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“…No immediate or long‐term adverse events occurred after eFTR. To date, techniques to receive full‐thickness gut biopsies have been laparoscopy or laparoscopy‐assisted extracorporal biopsy, endoscopy‐assisted percutaneous, transenteric approaches, and NOTES (Natural Orifice Transluminal Endoscopic Surgery) procedures combining EMR (endoscopic mucosa resection) with OTSC ® closure . All of these sophisticated methods are invasive, laborious, and risky partly due to the opening of the peritoneal cavity of any kind followed by gut closure in a second step.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic use of endoscopic full‐thickness wall resection (eFTR)—a novel minimally invasive technique for colonic tissue sampling in patients with severe gastrointestinal motility disorders

Valli

Pohl

Fried

et al. 2017

Neurogastroenterology Motil

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Background Complex gastrointestinal (GI) motility disorders such as chronic intestinal pseudo‐obstruction (CIPO) or Hirschsprung's disease (HD) are challenging to diagnose and treat appropriately. Thorough assessment of patient history, radiographic exams, endoscopy, and motility measurements aid in diagnostic workup, yet underlying histology is the cornerstone to enable a more distinct diagnosis of neuromuscular GI disorders. Traditionally, surgical procedures have been performed to obtain specimen suitable for accurate histologic analysis. Methods We performed endoscopic full‐thickness resection (eFTR) using a full‐thickness‐resection device (FTRD) under moderate propofol sedation in four patients with suspected severe neuromuscular gut disorders including CIPO. Key Results The mean age of the four patients was 43 y (range 19‐56 y). Technical and histological success providing large colonic full‐thickness tissue samples of excellent quality was achieved in all four patients (success rate 100%). The mean procedure time was 12 min (range 5‐20 min). The mean diameter of the resected specimen was 21 mm (range 20‐22 mm). No adverse events connected to the procedure itself occurred. Histology ranged from aganglionosis such as Hirschsprung's disease (HD) to hypoganglionosis and eosinophilic leiomyositis combined with lymphocytic ganglionitis in a third patient. Histology was unspecific in one patient. Conclusion and Inferences EFTR allows safe and minimal invasive harvesting of ample full‐thickness tissue samples for accurate histological analysis in patients with suspicion of neuromuscular gut disorders.

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“…Future research in humans will benefit by a recent breakthrough in obtaining nonsurgical gastric biopsies through percutaneous endoscopically assisted transenteric full-thickness gastric biopsy, 46 or antral muscularis propria biopsies utilizing endoscopic ultrasound guidance. 47 This ability to have nonsurgical access to smooth muscles will facilitate better understanding of ICC in different clinical settings including their role in the development of GP and as the predictors of response to medical therapies.…”

Section: Discussionmentioning

confidence: 99%

Is Interstitial Cells of Cajal‒opathy Present in Gastroparesis?

Bashashati

McCallum

2015

J Neurogastroenterol Motil

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Gastroparesis (GP), defined as delayed gastric emptying in the absence of any mechanical obstruction, is a challenging clinical condition, mainly because of limited treatment options. Studies in animal models of delayed gastric emptying as well as patients with gastroparesis revealed depletion or ultrastructural changes of interstitial cells of Cajal (ICC) in the gastric tissue, recently termed ICC-opathy. ICC are the pacemakers of the gastrointestinal tract and are involved in the transmission of the neuronal signaling to the smooth muscles. Therefore, lack of ICC could be one explanation of delayed gastric emptying in gastroparetic patients. How frequently ICC changes are observed in gastroparesis is not yet clear. In this review, the data on gastric ICC counts and morphology in animal models and patients with gastroparesis are discussed.

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Percutaneous endoscopically assisted transenteric full-thickness gastric biopsy: initial experience in humans

Cited by 13 publications

References 17 publications

Innovative gastric endoscopic muscle biopsy to identify all cell types, including myenteric neurons and interstitial cells of Cajal in patients with idiopathic gastroparesis: a feasibility study (with video)

Innovative gastric endoscopic muscle biopsy to identify all cell types, including myenteric neurons and interstitial cells of Cajal in patients with idiopathic gastroparesis: a feasibility study (with video)

Diagnostic use of endoscopic full‐thickness wall resection (eFTR)—a novel minimally invasive technique for colonic tissue sampling in patients with severe gastrointestinal motility disorders

Is Interstitial Cells of Cajal‒opathy Present in Gastroparesis?

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