Tissue sampling and analysis

Douglas O. Faigel, Glenn M. Eisen, Todd H. Baron, Jason A. Dominitz, Jay L. Goldstein, William K. Hirota, Brian C. Jacobson, John F. Johanson, Jonathan A. Leighton, J. Shaw Mallery, Kathryn A. Peterson, Hareth M. Raddawi, John J. Varg, J. Patrick Waring, Robert D. Fanelli, Jo Wheeler-Harbough

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Tissue sampling is useful in differentiating malignant, inflammatory, and infectious processes [C]. Techniques include pinch forceps biopsy, brush cytology, snare excision, and FNA [B]. For malignant lesions, maximal yield is attained with 8 to 10 biopsies [A]. Patients with Barrett's esophagus should undergo systematic biopsy to evaluate for dysplasia [C]. Patients with Barrett's esophagus and high-grade dysplasia should have 4-quadrant biopsies performed every 1 to 2 cm to detect underlying carcinoma [A, B]. Endoscopic mucosal resection may be used to remove malignant or premalignant mucosal lesions [B]. Infectious conditions require multiple biopsies, and if ulcers are present these should be obtained from both the center and edge; brushing and viral culture are adjunctive techniques [B]. H pylori infection can be assessed by gastric biopsy submitted for histologic examination or rapid urease testing [A]. Biopsy of the incisura angularis gives the highest yield for H pylori in untreated patients, but those who have been treated or are taking proton pump inhibitors or antibiotics should have specimens of the corpus and fundus taken as well [A]. Gastric polyps should be extensively sampled or removed when feasible [C]. Gastric polypectomy may carry a higher risk of bleeding than colon polypectomy and postprocedure acid suppressive therapy should be considered [B]. Random biopsies of the small intestine are indicated in the evaluation of diarrheal states, celiac disease, or infections [C]. Duodenal adenomas may be sporadic or associated with familial adenomatosis polyposis and should be sampled or removed when feasible [C]. Colon lesions should be endoscopically excised (polypectomy, EMR) or sampled if lesions are too numerous or removal is not technically feasible [C]. In patients with acute colitis, biopsy may help establish an etiology [B]. Patients with longstanding chronic colitis should undergo systematic surveillance to detect dysplasia, which may indicate an increased risk of cancer [B]. In patients with diarrhea, random biopsy of normal-appearing colonic mucosa may reveal microscopic colitis [B].

Original languageEnglish (US)
Pages (from-to)811-816
Number of pages6
JournalGastrointestinal endoscopy
Issue number7
StatePublished - Jun 2003

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology


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