Adequacy of mucosal sampling with the "two-bite" forceps technique: a prospective, randomized, blinded study

Area of Science:

• Gastroenterology
• Endoscopic Procedures
• Histopathology

Background:

• The
• two-bite
• technique for mucosal biopsy is common but its adequacy, particularly for the second sample, is not well-established.
• Studies are needed to evaluate specimen adequacy and potential risks associated with this method.

Purpose of the Study:

• To prospectively evaluate the adequacy of mucosal biopsy specimens obtained using the
• two-bite
• technique with three different forceps types.
• To compare the adequacy and integrity of the first and second biopsy samples obtained with the
• two-bite
• technique versus single-bite samples.

Main Methods:

• A prospective study involving patients undergoing diagnostic EGD (esophagogastroduodenoscopy).
• Mucosal biopsy specimens were collected using the
• two-bite
• technique (4 specimens) and single-bite technique (2 specimens) from the esophagus and stomach.
• An experienced pathologist, blinded to the technique and forceps used, assessed specimen adequacy, integrity, depth, and number submitted.

Main Results:

• The
• two-bite
• technique resulted in a significantly higher rate of missing samples (18.2%) compared to the single-bite technique (2.1%).
• First samples were lost more frequently (25%) than second samples (11.5%) with the
• two-bite
• technique.
• No significant differences were found in specimen adequacy, integrity, or depth between first and second samples, or between the
• two-bite
• and single-bite techniques.

Conclusions:

• While the second mucosal sample from the
• two-bite
• technique is histopathologically adequate, the technique carries a significant risk of sample loss, particularly for the first specimen.
• Forceps without a spike were associated with a higher incidence of missing samples, suggesting potential for increased sampling error.