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Esophagitis: optimizing diagnostic yield by biopsy orientation.

Nicola Brindley1, J M Sloan, W A McCallion

  • 1Department of Pediatric Surgery Royal Belfast Hospital for Sick Children, Royal Group of Hospitals Trust, London, UK. Nicola.Brindley@bartsandthelondon.nhs.uk

Journal of Pediatric Gastroenterology and Nutrition
|August 21, 2004
PubMed
Summary
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Orienting esophageal pinch biopsies significantly improves the diagnosis of esophagitis in children with gastroesophageal reflux (GER). This simple technique enhances histologic appraisal for better diagnostic yield.

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.

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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.