Advertisement

Endoscopic Tools/Techniques for Tissue Sampling

  • Daniel von Renteln
  • Melina C. VassiliouEmail author
Chapter

Abstract

In 1932, the semiflexible endoscope was developed by Rudolph Schindler, thus permitting endoscopic inspection of the stomach. A modification in 1938 allowed photo-documentation and introduced a working channel through which biopsies could be performed. The first fully flexible endoscope was then introduced in 1957 by Basil Hirschowitz. These developments set the foundation for modern gastrointestinal endoscopy. The flexible endoscope is now an indispensable tool for the visualization and diagnosis of inflammatory, infectious, premalignant and malignant gastrointestinal diseases. Endoscopic tissue sampling is an essential part of the diagnostic process and permits histopathologic evaluation of lesions detected by endoscopy. This chapter reviews tools and techniques for endoscopic tissue sampling. Image-enhanced techniques such as virtual histology and recommended biopsy and screening protocols for the most common gastrointestinal pathologies are also discussed.

Keywords

Optical Coherence Tomography Celiac Disease Endoscopic Mucosal Resection Narrow Band Imaging Eosinophilic Esophagitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Video 7.1

EUS-FNA using the ProCore needle (M4V 9199 kb)

References

  1. 1.
    Salmore R. Our heritage: a history of gastroenterology and gastroenterology nursing. Gastroenterol Nurs. 1998;21:40–3.CrossRefPubMedGoogle Scholar
  2. 2.
    Faigel DO, Eisen GM, Baron TH, Dominitz JA, Goldstein JL, Hirota WK, et al. Tissue sampling and analysis. Gastrointest Endosc. 2003;57:811–6.CrossRefPubMedGoogle Scholar
  3. 3.
    Gilbert DA, DiMarino AJ, Jensen DM, Katon R, Kimmey MB, Laine LA, et al. Status evaluation: hot biopsy forceps. American Society for Gastrointestinal Endoscopy. Technology Assessment Committee. Gastrointest Endosc. 1992;38:753–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Gibbs DH, Opelka FG, Beck DE, Hicks TC, Timmcke AE, Gathright Jr JB. Postpolypectomy colonic hemorrhage. Dis Colon Rectum. 1996;39:806–10.CrossRefPubMedGoogle Scholar
  5. 5.
    Rosen L, Bub DS, Reed 3rd JF, Nastasee SA. Hemorrhage following colonoscopic polypectomy. Dis Colon Rectum. 1993;36:1126–31.CrossRefPubMedGoogle Scholar
  6. 6.
    Waye JD, Lewis BS, Yessayan S. Colonoscopy: a prospective report of complications. J Clin Gastroenterol. 1992;15:347–51.CrossRefPubMedGoogle Scholar
  7. 7.
    Sorbi D, Norton I, Conio M, Balm R, Zinsmeister A, Gostout CJ. Postpolypectomy lower GI bleeding: descriptive analysis. Gastrointest Endosc. 2000;51:690–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Buddingh KT, Herngreen T, Haringsma J, van der Zwet WC, Vleggaar FP, Breumelhof R, et al. Location in the right hemi-colon is an independent risk factor for delayed post-polypectomy hemorrhage: a multi-center case-control study. Am J Gastroenterol. 2011;106:1119–24.CrossRefPubMedGoogle Scholar
  9. 9.
    Dyer WS, Quigley EM, Noel SM, Camacho KE, Manela F, Zetterman RK. Major colonic hemorrhage following electrocoagulating (hot) biopsy of diminutive colonic polyps: relationship to colonic location and low-dose aspirin therapy. Gastrointest Endosc. 1991;37:361–4.CrossRefPubMedGoogle Scholar
  10. 10.
    Trecca A, Gaj F, Di Lorenzo GP, Ricciardi MR, Silano M, Bella A, et al. Improved detection of colorectal neoplasms with selective use of chromoendoscopy in 2005 consecutive patients. Tech Coloproctol. 2006;10:339–44.CrossRefPubMedGoogle Scholar
  11. 11.
    Uraoka T, Saito Y, Ikematsu H, Yamamoto K, Sano Y. Sano’s capillary pattern classification for narrow-band imaging of early colorectal lesions. Dig Endosc. 2011;23 Suppl 1:112–5.CrossRefPubMedGoogle Scholar
  12. 12.
    Cha JM, Lee JI, Joo KR, Jung SW, Shin HP. A prospective randomized study on computed virtual chromoendoscopy versus conventional colonoscopy for the detection of small colorectal adenomas. Dig Dis Sci. 2010;55:2357–64.CrossRefPubMedGoogle Scholar
  13. 13.
    Adler A, Aschenbeck J, Yenerim T, Mayr M, Aminalai A, Drossel R, et al. Narrow-band versus white-light high definition television endoscopic imaging for screening colonoscopy: a prospective randomized trial. Gastroenterology. 2009;136:410–6.e1; quiz 715.CrossRefPubMedGoogle Scholar
  14. 14.
    Adler A, Wegscheider K, Lieberman D, Aminalai A, Aschenbeck J, Drossel R, et al. Factors determining the quality of screening colonoscopy: a prospective study on adenoma detection rates, from 12 134 examinations (Berlin colonoscopy project 3, BECOP-3). Gut. 2013;62(2):236–41.CrossRefPubMedGoogle Scholar
  15. 15.
    Aminalai A, Rosch T, Aschenbeck J, Mayr M, Drossel R, Schroder A, et al. Live image processing does not increase adenoma detection rate during colonoscopy: a randomized comparison between FICE and conventional imaging (Berlin Colonoscopy Project 5, BECOP-5). Am J Gastroenterol. 2010;105:2383–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Vemulapalli KC, Rex DK. Evolving techniques in colonoscopy. Curr Opin Gastroenterol. 2011;27:430–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Adler A, Pohl H, Papanikolaou IS, Abou-Rebyeh H, Schachschal G, Veltzke-Schlieker W, et al. A prospective randomised study on narrow-band imaging versus conventional colonoscopy for adenoma detection: does narrow-band imaging induce a learning effect? Gut. 2008;57:59–64.CrossRefPubMedGoogle Scholar
  18. 18.
    Shukla R, Abidi WM, Richards-Kortum R, Anandasabapathy S. Endoscopic imaging: how far are we from real-time histology? World J Gastrointest Endosc. 2011;3:183–94.CrossRefPubMedCentralPubMedGoogle Scholar
  19. 19.
    Adler DC, Zhou C, Tsai TH, Lee HC, Becker L, Schmitt JM, et al. Three-dimensional optical coherence tomography of Barrett’s esophagus and buried glands beneath neosquamous epithelium following radiofrequency ablation. Endoscopy. 2009;41:773–6.CrossRefPubMedCentralPubMedGoogle Scholar
  20. 20.
    Cobb MJ, Hwang JH, Upton MP, Chen Y, Oelschlager BK, Wood DE, et al. Imaging of subsquamous Barrett’s epithelium with ultrahigh-resolution optical coherence tomography: a histologic correlation study. Gastrointest Endosc. 2010;71:223–30.CrossRefPubMedGoogle Scholar
  21. 21.
    Seitz U, Freund J, Jaeckle S, Feldchtein F, Bohnacker S, Thonke F, et al. First in vivo optical coherence tomography in the human bile duct. Endoscopy. 2001;33:1018–21.CrossRefPubMedGoogle Scholar
  22. 22.
    Poneros JM, Tearney GJ, Shiskov M, Kelsey PB, Lauwers GY, Nishioka NS, et al. Optical coherence tomography of the biliary tree during ERCP. Gastrointest Endosc. 2002;55:84–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Arvanitakis M, Hookey L, Tessier G, Demetter P, Nagy N, Stellke A, et al. Intraductal optical coherence tomography during endoscopic retrograde cholangiopancreatography for investigation of biliary strictures. Endoscopy. 2009;41:696–701.CrossRefPubMedGoogle Scholar
  24. 24.
    Ussui VM, Wallace MB. Confocal endomicroscopy of colorectal polyps. Gastroenterol Res Pract. 2012;2012:545679.PubMedCentralPubMedGoogle Scholar
  25. 25.
    Chey WD, Wong BCY, Practice Parameters Committee of the American College of Gastroenterology. American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol. 2007;102:1808–25.CrossRefPubMedGoogle Scholar
  26. 26.
    Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R, Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101:1900–20; quiz 1943.CrossRefPubMedGoogle Scholar
  27. 27.
    Reid BJ, Blount PL, Feng Z, Levine DS. Optimizing endoscopic biopsy detection of early cancers in Barrett’s high-grade dysplasia. Am J Gastroenterol. 2000;95:3089–96.CrossRefPubMedGoogle Scholar
  28. 28.
    Gonzalez S, Yu WM, Smith MS, Slack KN, Rotterdam H, Abrams JA, et al. Randomized comparison of 3 different-sized biopsy forceps for quality of sampling in Barrett’s esophagus. Gastrointest Endosc. 2010;72:935–40.CrossRefPubMedCentralPubMedGoogle Scholar
  29. 29.
    Levine DS, Haggitt RC, Blount PL, Rabinovitch PS, Rusch VW, Reid BJ. An endoscopic biopsy protocol can differentiate high-grade dysplasia from early adenocarcinoma in Barrett’s esophagus. Gastroenterology. 1993;105:40–50.PubMedGoogle Scholar
  30. 30.
    Spechler SJ, Sharma P, Souza RF, Inadomi JM, Shaheen NJ. American Gastroenterological Association medical position statement on the management of Barrett’s esophagus. Gastroenterology. 2011;140:1084–91.CrossRefPubMedGoogle Scholar
  31. 31.
    Hulscher JB, Haringsma J, Benraadt J, Offerhaus GJ, ten Kate FJ, Baak JP, et al. Comprehensive Cancer Centre Amsterdam Barrett Advisory Committee: first results. Neth J Med. 2001;58:3–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Kahrilas PJ, Shaheen NJ, Vaezi MF, Hiltz SW, Black E, Modlin IM, et al. American Gastroenterological Association Medical Position Statement on the management of gastroesophageal reflux disease. Gastroenterology. 2008;135:1383–91. 1391.e1–5.CrossRefPubMedGoogle Scholar
  33. 33.
    Ammoury RF, Rosenman MB, Roettcher D, Gupta SK. Incidental gastric eosinophils in patients with eosinophilic esophagitis: do they matter? J Pediatr Gastroenterol Nutr. 2010;51:723–6.CrossRefPubMedGoogle Scholar
  34. 34.
    van IJzendoorn MC, Laheij RJF, de Boer WA, Jansen JBMJ. The importance of corpus biopsies for the determination of Helicobacter pylori infection. Neth J Med. 2005;63:141–5.PubMedGoogle Scholar
  35. 35.
    Weston AP, Campbell DR, Hassanein RS, Cherian R, Dixon A, McGregor DH. Prospective, multivariate evaluation of CLOtest performance. Am J Gastroenterol. 1997;92:1310–5.PubMedGoogle Scholar
  36. 36.
    Laine L, Sugg J, Suchower L, Neil G. Endoscopic biopsy requirements for post-treatment diagnosis of Helicobacter pylori. Gastrointest Endosc. 2000;51:664–9.CrossRefPubMedGoogle Scholar
  37. 37.
    Graham DY, Genta R, Evans DG, Reddy R, Clarridge JE, Olson CA, et al. Helicobacter pylori does not migrate from the antrum to the corpus in response to omeprazole. Am J Gastroenterol. 1996;91:2120–4.PubMedGoogle Scholar
  38. 38.
    Hatfield AR, Slavin G, Segal AW, Levi AJ. Importance of the site of endoscopic gastric biopsy in ulcerating lesions of the stomach. Gut. 1975;16:884–6.CrossRefPubMedCentralPubMedGoogle Scholar
  39. 39.
    Graham DY, Schwartz JT, Cain GD, Gyorkey F. Prospective evaluation of biopsy number in the diagnosis of esophageal and gastric carcinoma. Gastroenterology. 1982;82:228–31.PubMedGoogle Scholar
  40. 40.
    Banerjee S, Cash BD, Dominitz JA, Baron TH, Anderson MA, Ben-Menachem T, et al. The role of endoscopy in the management of patients with peptic ulcer disease. Gastrointest Endosc. 2010;71:663–8.CrossRefPubMedGoogle Scholar
  41. 41.
    Genta RM, Graham DY. Comparison of biopsy sites for the histopathologic diagnosis of Helicobacter pylori: a topographic study of H. pylori density and distribution. Gastrointest Endosc. 1994;40:342–5.CrossRefPubMedGoogle Scholar
  42. 42.
    Jalving M, Koornstra JJ, Wesseling J, Boezen HM, De Jong S, Kleibeuker JH. Increased risk of fundic gland polyps during long-term proton pump inhibitor therapy. Aliment Pharmacol Ther. 2006;24:1341–8.CrossRefPubMedGoogle Scholar
  43. 43.
    el-Zimaity HM, Jackson FW, Graham DY. Fundic gland polyps developing during omeprazole therapy. Am J Gastroenterol. 1997;92:1858–60.PubMedGoogle Scholar
  44. 44.
    Choudhry U, Boyce Jr HW, Coppola D. Proton pump inhibitor-associated gastric polyps: a retrospective analysis of their frequency, and endoscopic, histologic, and ultrastructural characteristics. Am J Clin Pathol. 1998;110:615–21.PubMedGoogle Scholar
  45. 45.
    Bertoni G, Sassatelli R, Nigrisoli E, Pennazio M, Tansini P, Arrigoni A, et al. Dysplastic changes in gastric fundic gland polyps of patients with familial adenomatous polyposis. Ital J Gastroenterol Hepatol. 1999;31:192–7.PubMedGoogle Scholar
  46. 46.
    Domizio P, Talbot IC, Spigelman AD, Williams CB, Phillips RK. Upper gastrointestinal pathology in familial adenomatous polyposis: results from a prospective study of 102 patients. J Clin Pathol. 1990;43:738–43.CrossRefPubMedCentralPubMedGoogle Scholar
  47. 47.
    Lynch HT, Snyder C, Davies JM, Lanspa S, Lynch J, Gatalica Z, et al. FAP, gastric cancer, and genetic counseling featuring children and young adults: a family study and review. Fam Cancer. 2010;9:581–8.CrossRefPubMedGoogle Scholar
  48. 48.
    Ginsberg GG, Al-Kawas FH, Fleischer DE, Reilly HF, Benjamin SB. Gastric polyps: relationship of size and histology to cancer risk. Am J Gastroenterol. 1996;91:714–7.PubMedGoogle Scholar
  49. 49.
    Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Int J Surg Pathol. 2002;10:81–9.CrossRefPubMedGoogle Scholar
  50. 50.
    Pais WP, Duerksen DR, Pettigrew NM, Bernstein CN. How many duodenal biopsy specimens are required to make a diagnosis of celiac disease? Gastrointest Endosc. 2008;67:1082–7.CrossRefPubMedGoogle Scholar
  51. 51.
    Green PHR, Cellier C. Celiac disease. N Engl J Med. 2007;357:1731–43.CrossRefPubMedGoogle Scholar
  52. 52.
    Weber A, von Weyhern C, Fend F, Schneider J, Neu B, Meining A, et al. Endoscopic transpapillary brush cytology and forceps biopsy in patients with hilar cholangiocarcinoma. World J Gastroenterol. 2008;14:1097–101.CrossRefPubMedCentralPubMedGoogle Scholar
  53. 53.
    Ramchandani M, Reddy DN, Gupta R, Lakhtakia S, Tandan M, Darisetty S, et al. Role of single-operator peroral cholangioscopy in the diagnosis of indeterminate biliary lesions: a single-center, prospective study. Gastrointest Endosc. 2011;74:511–9.CrossRefPubMedGoogle Scholar
  54. 54.
    Shah RJ, Langer DA, Antillon MR, Chen YK. Cholangioscopy and cholangioscopic forceps biopsy in patients with indeterminate pancreaticobiliary pathology. Clin Gastroenterol Hepatol. 2006;4:219–25.CrossRefPubMedGoogle Scholar
  55. 55.
    Draganov PV, Chauhan S, Wagh MS, Gupte AR, Lin T, Hou W, et al. Diagnostic accuracy of conventional and cholangioscopy-guided sampling of indeterminate biliary lesions at the time of ERCP: a prospective, long-term follow-up study. Gastrointest Endosc. 2012;75:347–53.CrossRefPubMedGoogle Scholar
  56. 56.
    Hartman DJ, Slivka A, Giusto DA, Krasinskas AM. Tissue yield and diagnostic efficacy of fluoroscopic and cholangioscopic techniques to assess indeterminate biliary strictures. Clin Gastroenterol Hepatol. 2012;10(9):1042–6.CrossRefPubMedGoogle Scholar
  57. 57.
    Waxman I, Dillon T, Chmura K, Wardrip C, Chennat J, Konda V. Feasibility of a novel system for intraductal balloon-anchored direct peroral cholangioscopy and endotherapy with an ultraslim endoscope (with videos). Gastrointest Endosc. 2010;72:1052–6.CrossRefPubMedGoogle Scholar
  58. 58.
    Moon JH, Ko BM, Choi HJ, Koo HC, Hong SJ, Cheon YK, et al. Direct peroral cholangioscopy using an ultra-slim upper endoscope for the treatment of retained bile duct stones. Am J Gastroenterol. 2009;104:2729–33.CrossRefPubMedGoogle Scholar
  59. 59.
    Moon JH, Choi HJ, Ko BM. Therapeutic role of direct peroral cholangioscopy using an ultra-slim upper endoscope. J Hepatobiliary Pancreat Sci. 2011;18:350–6.CrossRefPubMedGoogle Scholar
  60. 60.
    Kim HI, Moon JH, Choi HJ, Lee JC, Ahn HS, Song AR, et al. Holmium laser lithotripsy under direct peroral cholangioscopy by using an ultra-slim upper endoscope for patients with retained bile duct stones (with video). Gastrointest Endosc. 2011;74:1127–32.CrossRefPubMedGoogle Scholar
  61. 61.
    Choi HJ, Moon JH, Ko BM, Hong SJ, Koo HC, Cheon YK, et al. Overtube-balloon-assisted direct peroral cholangioscopy by using an ultra-slim upper endoscope (with videos). Gastrointest Endosc. 2009;69:935–40.CrossRefPubMedGoogle Scholar
  62. 62.
    Komorowski RA, Beggs BK, Geenan JE, Venu RP. Assessment of ampulla of Vater pathology. An endoscopic approach. Am J Surg Pathol. 1991;15:1188–96.CrossRefPubMedGoogle Scholar
  63. 63.
    Cannon ME, Carpenter SL, Elta GH, Nostrant TT, Kochman ML, Ginsberg GG, et al. EUS compared with CT, magnetic resonance imaging, and angiography and the influence of biliary stenting on staging accuracy of ampullary neoplasms. Gastrointest Endosc. 1999;50:27–33.CrossRefPubMedGoogle Scholar
  64. 64.
    Bohnacker S, Seitz U, Nguyen D, Thonke F, Seewald S, deWeerth A, et al. Endoscopic resection of benign tumors of the duodenal papilla without and with intraductal growth. Gastrointest Endosc. 2005;62:551–60.CrossRefPubMedGoogle Scholar
  65. 65.
    Catalano MF, Linder JD, Chak A, Sivak Jr MV, Raijman I, Geenen JE, et al. Endoscopic management of adenoma of the major duodenal papilla. Gastrointest Endosc. 2004;59:225–32.CrossRefPubMedGoogle Scholar
  66. 66.
    Giardiello FM, Lazenby AJ, Bayless TM, Levine EJ, Bias WB, Ladenson PW, et al. Lymphocytic (microscopic) colitis. Clinicopathologic study of 18 patients and comparison to collagenous colitis. Dig Dis Sci. 1989;34:1730–8.CrossRefPubMedGoogle Scholar
  67. 67.
    Yusoff IF, Ormonde DG, Hoffman NE. Routine colonic mucosal biopsy and ileoscopy increases diagnostic yield in patients undergoing colonoscopy for diarrhea. J Gastroenterol Hepatol. 2002;17:276–80.CrossRefPubMedGoogle Scholar
  68. 68.
    Itzkowitz SH, Present DH, Crohn’s and Colitis Foundation of America Colon Cancer in IBD Study Group. Consensus conference: colorectal cancer screening and surveillance in inflammatory bowel disease. Inflamm Bowel Dis. 2005;11:314–21.CrossRefPubMedGoogle Scholar
  69. 69.
    Leighton JA, Shen B, Baron TH, Adler DG, Davila R, Egan JV, et al. ASGE guideline: endoscopy in the diagnosis and treatment of inflammatory bowel disease. Gastrointest Endosc. 2006;63:558–65.CrossRefPubMedGoogle Scholar
  70. 70.
    Winawer SJ, Zauber AG, Fletcher RH, Stillman JS, O’Brien MJ, Levin B, et al. Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society. Gastroenterology. 2006;130:1872–85.CrossRefPubMedGoogle Scholar
  71. 71.
    Bond JH. Polyp guideline: diagnosis, treatment, and surveillance for patients with colorectal polyps. Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol. 2000;95:3053–63.CrossRefPubMedGoogle Scholar
  72. 72.
    Anderson MA, Ben-Menachem T, Gan SI, Appalaneni V, Banerjee S, Cash BD, et al. Management of antithrombotic agents for endoscopic procedures. Gastrointest Endosc. 2009;70:1060–70.CrossRefPubMedGoogle Scholar
  73. 73.
    American Joint Committee on Cancer (AJCC). AJCC cancer staging manual. 7th ed. New York: Springer; 2010.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of Interdisciplinary EndoscopyUniversity Hospital, University Medical Center Hamburg-EppendorfHamburgGermany
  2. 2.Department of SurgeryMontreal General Hospital, McGill UniversityMontrealCanada

Personalised recommendations