Esophagitis: optimizing diagnostic yield by biopsy orientation

Area of Science:

• Pediatric Gastroenterology
• Histopathology
• Diagnostic Optimization

Background:

• Gastroesophageal reflux (GER) diagnosis in children lacks correlation between symptoms, pH monitoring, and endoscopic/histologic findings.
• Optimizing esophagitis diagnosis in pediatric GER is crucial.

Purpose of the Study:

• To compare histologic evaluation of esophageal pinch and suction biopsies after orientation to improve childhood esophagitis diagnosis.
• To determine the optimal method for biopsy orientation.

Main Methods:

• Thirty pediatric patients (6 months–7 years) with GER underwent endoscopy and biopsy.
• Pinch and suction biopsies were examined with different orientation methods.
• Suction biopsy with x10 magnification orientation served as the standard for comparison.

Main Results:

• Oriented pinch biopsies with x10 magnification yielded 93% adequate samples.
• Oriented pinch biopsies without magnification yielded 90% adequate samples.
• Unoriented pinch biopsies had only 63% adequacy for diagnosis.

Conclusions:

• Orienting esophageal pinch biopsies enhances histologic appraisal and diagnostic yield for esophagitis in pediatric GER.
• Biopsy orientation can be easily performed in the endoscopy room.