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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
Insights
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.
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.
Objectives:
There is poor correlation between gastroesophageal reflux (GER) symptoms, intraesophageal pH monitoring and endoscopic or histologic appraisal of esophagitis in the pediatric age group. To optimize the diagnosis of childhood esophagitis, histologic evaluation of esophageal pinch and suction biopsies after orientation were compared.
Methods:
Thirty consecutive children with GER, age range 6 months to 7 years, were prospectively evaluated with upper gastrointestinal endoscopy and biopsy. Three pinch biopsies and one suction biopsy were examined after different methods of biopsy orientation. The suction biopsy orientated with x 10 magnification represented the standard against which the pinch biopsies were compared.
Results:
After suction biopsy with tissue orientation using x 10 magnification 90% of biopsies were adequate for histologic appraisal. Ninety-three percent of esophageal pinch biopsies orientated with x 10 magnification were adequate for analysis. After pinch biopsy orientated without magnification 90% of biopsies were suitable for histologic appraisal. Finally, in the pinch biopsy group without formal orientation, only 63% of the biopsies were adequate for histologic analysis and diagnosis of esophagitis.
Conclusion:
Orientation of esophageal pinch biopsies improves histologic appraisal and hence increases the diagnostic yield of esophagitis in children with GER. The tissue fragments can be easily orientated in the endoscopy room before placement in fixative.
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