Endoscopic Tissue Sampling: A Pathologist’s Perspective (Good Endoscopists Think Ahead)

Abstract

Few endoscopists think further than the immediate question when taking biopsies, so thinking ahead is not usually part of endoscopic training. Further, it is very difficult to acquire this skill unless there is regular contact with a pathologist interested in GI pathology, such as might occur with regular biopsy rounds. Some diagnoses require clinical/endoscopic input particularly regarding either endoscopic appearances or medications the patient is taking; in the absence of which, the pathologists’ response is likely to be descriptive and that “clinical correlation is required.” In some instances this is inevitable if the histological diagnosis is unexpected, but usually it can be anticipated. When the pathologist has this information, then he/she may be in the best position to make the correlation, but in its absence it is easily shifted back to the clinician – a responsibility that pathologists are very willing to abrogate. This chapter will look at situations in which the endoscopist can anticipate the potential issue(s) the pathologist is likely to consider when a specific question is asked, the assumption being that the pathologist is able to take this responsibility and that criteria are available to answer the question. At the end of the day, the objective is to make an accurate diagnosis and ensure the most appropriate therapy for the patient, while keeping everyone out of trouble from a diagnostic and management viewpoint.