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Diagnostic yield of tissue sampling using a bite-on-bite technique for incidental subepithelial lesions
Jeong-Seon Ji1, Bo-In Lee, Kyu-Yong Choi
1Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
The Korean Journal of Internal Medicine
|June 23, 2009
Summary
The bite-on-bite biopsy technique effectively diagnoses gastrointestinal subepithelial lesions in selected patients. This safe endoscopic method is particularly useful for incidental esophageal lesions, avoiding complications.
Area of Science:
- Gastroenterology
- Endoscopic Procedures
- Diagnostic Yield
Background:
- Conventional endoscopic techniques for gastrointestinal subepithelial lesions have limitations, including low diagnostic yields and high complication rates.
- Existing methods like jumbo biopsy, endoscopic ultrasonography (EUS), and EUS-guided fine needle aspiration present challenges.
- Endoscopic submucosal resection is also associated with limitations for initial diagnosis.
Purpose of the Study:
- To evaluate the diagnostic yield of the bite-on-bite technique for tissue sampling of incidental subepithelial lesions.
- To assess the safety and effectiveness of the bite-on-bite method in a clinical setting.
- To compare the diagnostic yield across different gastrointestinal locations.
Main Methods:
- The study involved 129 patients with 140 subepithelial lesions identified during conventional esophagogastroduodenoscopy.
- Bite-on-bite biopsies were performed on 37 lesions in 36 patients using conventional forceps.
- Multiple bites (2-8) were taken to obtain submucosal tissue, excluding hypervascular or thick epithelial lesions.
Main Results:
- The bite-on-bite technique achieved a diagnostic yield of 38% (14 out of 37 lesions).
- Minor bleeding occurred in five cases but was managed effectively with epinephrine injection or hemoclips.
- Diagnostic yield was higher in the esophagus (54%) compared to the stomach and duodenum (28%).
Conclusions:
- The bite-on-bite technique is a safe and effective method for diagnosing selected subepithelial lesions.
- This endoscopic approach is beneficial for incidental lesions, especially in the esophagus.
- Contraindications include lesions with a high bleeding risk or thick overlying epithelium.