An observer-blinded, prospective, randomized comparison of forceps for endoscopic esophageal biopsy

The designs of 2 new biopsy forceps attempt to address the difficulty of obtaining esophageal biopsy specimens. The angled design is a modified version of currently used straight forceps. The lateral cup forceps has a straight shaft with a bullet-shaped cuffing head for a tangential approach.

Seventy-five patients were enrolled in a prospective study in which 3 different forceps were compared in random order: a reusable straight-shaft spiked forceps, a reusable angled-shaft spiked forceps, and a disposable lateral cup forceps. Two biopsy specimens were obtained with each device per patient. Two pathologists, blinded as to forceps used, graded the tissue samples for size, histologic depth, shear artifact, crush artifact, and adequacy for diagnosis. Data were compared by using multivariate analysis of variance and Scheffé's method.

Analysis of variance showed overall differences in specimen size, histologic depth score, and diagnostic adequacy (p < 0.001). There was no significant difference for crush (p = 0.459) or shear artifacts (p = 0.243). Pair-wise comparisons demonstrated that tissue samples obtained with the straight forceps were larger (p = 0.020) and deeper (p = 0.040) than the angled forceps. These 2 designs were similar in terms of diagnostic adequacy. Biopsy specimens obtained with the straight forceps were larger (p < 0.001) and deeper (p < 0.001) than those obtained with the lateral cup forceps. Both the straight and angled forceps were superior to the lateral cup forceps in terms of diagnostic adequacy (p = 0.020, p = 0.008, respectively).

The reusable straight-shaft spiked forceps provides larger and deeper esophageal biopsy specimens than either the angled or lateral cup forceps. The angled forceps provides specimens of similar adequacy for diagnosis compared with the straight forceps. The lateral cup forceps should not be used in the esophagus.