Abstract
Background
Obtaining quality endoscopic biopsy specimens is vital in making successful histological diagnoses. The influence of forceps cup shape and size on quality of biopsy specimens is unclear.
Aim
To identify whether oval cup or two different serrated jaw biopsy forceps could obtain specimens of superior size. Secondary endpoints were tissue adequacy, depth of tissue acquisition, and crush artifact.
Methods
A single-center, prospective, pathologist-masked, randomized controlled trial was performed. In total 136 patients with a clinical indication for esophagogastroduodenoscopy with biopsy were randomized to receive serial biopsies with a large-capacity serrated forceps with jaw diameter 2.2 mm (SER1) and either a large-capacity oval forceps with jaw diameter 2.4 mm (OVL) or large-capacity serrated biopsy forceps with jaw diameter 2.4 mm (SER2) in two parallel groups.
Results
SER2 provided significantly larger specimens than did the other forceps (SER2 3.26 ± 1.09 vs. SER1 2.92 ± 0.88 vs. OVL 2.92 ± 0.76; p = 0.026), with an average size difference of 0.34 mm greater with SER2 compared to SER1 and OVL. OVL provided significantly deeper biopsies compared to SER1 and SER2 (p = 0.02), with 31 % of OVL biopsies reaching the submucosa. SER2 had significantly less crush artifact than SER1 and OVL (p < 0.0001).
Conclusion
Serrated forceps provided larger samples compared to oval jaw forceps of the same size, with SER2 providing the largest specimen size. Oval cup forceps had deeper penetration of epithelium, while the larger jaw diameter serrated jaw forceps had less crush artifact. All three forceps provided specimens adequate for diagnostic purposes.
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References
Hatfield AR, Slavin G, Segal AW, Levi AJ. Importance of the site of endoscopic gastric biopsy in ulcerating lesions of the stomach. Gut. 1975;16:884–886.
Landres RT, Strum WB. Endoscopic techniques in the diagnosis of gastric adenocarcinoma. Gastrointest Endosc. 1977;23:203–205.
Sancho-Poch FJ, Balanzo J, Ocana J, et al. An evaluation of gastric biopsy in the diagnosis of gastric cancer. Gastrointest Endosc. 1978;24:281–282.
Winawer SJ, Posner G, Lightdale CJ, Sherlock P, Melamed M, Fortner JG. Endoscopic diagnosis of advanced gastric cancer. Factors influencing yield. Gastroenterology. 1975;69:1183–1187.
Danesh BJ, Burke M, Newman J, Aylott A, Whitfield P, Cotton PB. Comparison of weight, depth, and diagnostic adequacy of specimens obtained with 16 different biopsy forceps designed for upper gastrointestinal endoscopy. Gut. 1985;26:227–231.
Walter T, Chesnay AL, Dumortier J, et al. Biopsy specimens obtained with small-caliber endoscopes have comparable diagnostic performances than those obtained with conventional endoscopes: a prospective study on 1335 specimens. J Clin Gastroenterol. 2010;44:12–17.
Siegel M, Barkin JS, Rogers AI, Thomsen S, Clark R. Gastric biopsy: a comparison of biopsy forceps. Gastrointest Endosc. 1983;29:35–36.
Elmunzer BJ, Higgins PD, Kwon YM, et al. Jumbo forceps are superior to standard large-capacity forceps in obtaining diagnostically adequate inflammatory bowel disease surveillance biopsy specimens. Gastrointest Endosc. 2008;68:273–278; quiz 334, 336.
Komanduri S, Swanson G, Keefer L, Jakate S. Use of a new jumbo forceps improves tissue acquisition of Barrett’s esophagus surveillance biopsies. Gastrointest Endosc. 2009;70:1072.e1–1078.e1.
Draganov PV, Chang MN, Alkhasawneh A, et al. Randomized, controlled trial of standard, large-capacity versus jumbo biopsy forceps for polypectomy of small, sessile, colorectal polyps. Gastrointest Endosc. 2012;75:118–126.
Bernstein DE, Barkin JS, Reiner DK, Lubin J, Phillips RS, Grauer L. Standard biopsy forceps versus large-capacity forceps with and without needle. Gastrointest Endosc. 1995;41:573–576.
Abudayyeh S, Hoffman J, El-Zimaity HT, Graham DY. Prospective, randomized, pathologist-blinded study of disposable alligator-jaw biopsy forceps for gastric mucosal biopsy. Dig Liver Dis. 2009;41:340–344.
Woods KL, Anand BS, Cole RA, et al. Influence of endoscopic biopsy forceps characteristics on tissue specimens: results of a prospective randomized study. Gastrointest Endosc. 1999;49:177–183.
Acknowledgments
As part of this investigator initiated study, Radial Jaw 4 (SER2) forceps were provided by Boston Scientific (Natick, MA, USA). Oval cup forceps with spike were provided by Cook Endoscopy (Winston-Salem, NC, USA). Funding to cover costs of histology processing of the additional biopsy specimens that would not have been part of routine clinical care was provided by Boston Scientific and Cook Endoscopy.
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The authors report no additional relevant financial disclosures or conflicts of interest. Study sponsors played no role in the design or execution of the study, analysis of the results, or manuscript drafting.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Institutional review board approval was obtained.
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Informed consent was obtained from all individual participants included in the study.
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Sussman, D.A., Deshpande, A.R., Shankar, U. et al. Comparison of Performance Characteristics of Oval Cup Forceps Versus Serrated Jaw Forceps in Gastric Biopsy. Dig Dis Sci 61, 2338–2343 (2016). https://doi.org/10.1007/s10620-016-4129-y
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DOI: https://doi.org/10.1007/s10620-016-4129-y