Colitis pp 37-48 | Cite as

The Endoscopic Biopsy: How to Proceed and How to Look at a Biopsy

  • Anne Jouret-MourinEmail author
  • Karel Geboes


Pathology is one of the tools for reaching a diagnosis. Like all procedures in medicine, the analysis of biopsies has some limitations. The diagnostic yield can be increased by using good quality samples, by optimizing the number of samples and sections, by optimal preparation of the samples and by confronting the findings with appropriate clinical information. Numbers of samples needed depend on the indication for the endoscopic procedures. When reading a biopsy, analysis can be improved with a systematic approach. This implies a proper knowledge of the normal histology and of potential artifacts. The pathologists should take note of the origin, the number, and the size of the samples and subsequently evaluate the architecture and cytological aspects of the specimen. The analysis can be improved by using a checklist or pro forma report.


Endoscopic biopsy Diagnostic yield Sampling Sampling error Diagnostic accuracy Orientation Optimal number of biopsies Number of biopsies Origin of biopsies Size of biopsies Architecture Sensitivity Specificity Artifact Bowel preparation Pseudolipomatosis Barium 


  1. 1.
    Farmer M, Petras RE, Hunt LE, et al. The importance of diagnostic accuracy in colonic inflammatory bowel disease. Am J Gastroenterol. 2000;95:3184–8.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Bentley E, Jenkins D, Campbell F, Warren BF. How could pathologists improve the initial diagnosis of colitis? Evidence from an international workshop. J Clin Pathol. 2002;55:955–60.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Sandler RS, Cummings MS, Keku TO, et al. Disposable versus reusable forceps for colorectal epithelial cell proliferation in humans. Cancer Epidemiol Biomark Prev. 2000;9:1123–5.Google Scholar
  4. 4.
    Abreu MT, Harpaz N. Diagnosis of colitis: making the initial diagnosis. Clin Gastroenterol Hepatol. 2007;5:295–301.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Magro F, Langner C, Driessen A, et al. European consensus on the histopathology of inflammatory bowel disease. J Crohns Colitis. 2013;7:827–51.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Rosenstock E, Farmer RG, Petras R, et al. Surveillance for colonic carcinoma in ulcerative colitis. Gastroenterology. 1985;89:1342–6.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Rubin CE, Haggitt RC, et al. DNA-aneuploidy in colonic biopsies predicts future development of dysplasia in ulcerative colitis. Gastroenterology. 1992;103:1611–20.CrossRefPubMedGoogle Scholar
  8. 8.
    Kornbluth A, Sachar DB. Ulcerative colitis practice guidelines in adults. American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol. 1997;2:204–11.Google Scholar
  9. 9.
    Seldenrijk CA, Morson BC, Meuwissen SGM, et al. Histopathological evaluation of colonic mucosal biopsy specimens in chronic inflammatory bowel disease: diagnostic implications. Gut. 1991;32:1514–20.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Theodossi A, Spiegelhalter DJ, Jass J, et al. Observer variation and discriminatory value of biopsy features in inflammatory bowel disease. Gut. 1994;35:961–8.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Surawicz CM. Serial sectioning of a portion of a rectal biopsy detects more focal abnormalities. A prospective study of patients with inflammatory bowel disease. Dig Dis Sci. 1982;27:434–6.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Jenkins D, Balsitis M, Gallivan S, et al. Guidelines for the initial biopsy diagnosis of suspected chronic idiopathic inflammatory bowel disease. The British Society of Gastroenterology Initiative. J Clin Pathol. 1997;50:93–105.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Terada T. Histopathological study of the rectum in 1,438 consecutive rectal specimens in a single Japanese hospital: 1. Benign lesions. Int J Clin Exp Pathol. 2013;26:349–57.Google Scholar
  14. 14.
    Burks ML, Kundrotas L. Unusual colon biopsy. Gastroenterology. 2013;145:e10–1.CrossRefPubMedGoogle Scholar
  15. 15.
    Rashid A, Hamilton SR. Necrosis of the gastrointestinal tract in uremic patients as a result of sodium polystyrene sulfonate (Kayexalate) in sorbitol: an under-recognized condition. Am J Surg Pathol. 1997;21:60–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Koteish A, Kannangai R, Abrahma SC, et al. Colonic spirochetosis in children and adults. Am J Clin Pathol. 2003;120:828–32.CrossRefPubMedGoogle Scholar
  17. 17.
    Swanson BJ, Limketkai BN, Liu TC, et al. Sevelamer crystals in the gastrointestinal tract (GIT): a new entity associated with mucosal injury. Am J Surg Pathol. 2013;37:1686–93.CrossRefPubMedGoogle Scholar
  18. 18.
    Connor A, Tolan D, Hughes S, et al. Consensus guidelines for the safe prescription and administration of oral bowel-cleansing agents. Gut. 2012;61:1525–32.CrossRefPubMedGoogle Scholar
  19. 19.
    Wexner SD, Beck DE, Baron TH, et al. A consensus document on bowel preparation before colonoscopy prepared by a task force from the American Society of Colon and Rectal Surgeons, the American Society for Gastrointestinal Endoscopy and the Society of American Gastrointestinal and Endoscopic Surgeons. Gastrointest Endosc. 2006;63(7):894–909.CrossRefPubMedGoogle Scholar
  20. 20.
    Rejchrt S, Bures J, Siroky M, Kopacova M, Slezak L, Langr F. A prospective observational study of colonic mucosal abnormalities associated with orally administrated sodium phosphate for colon cleansing before colonoscopy. Gastrointest Endosc. 2004;59:651–4.CrossRefPubMedGoogle Scholar
  21. 21.
    Croucher LJ, Bury JP, Williams EA, et al. Commonly used bowel preparations have significant and different effects upon cell proliferation in the colon: a pilot study. BMC Gastroenterol. 2008;8:54.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Snover DC, Sandstad J, Hutton S. Mucosal pseudolipomatosis of the colon. Am J Clin Pathol. 1985;84:575–80.CrossRefPubMedGoogle Scholar
  23. 23.
    Kara M, Turan I, Polat Z, et al. Chemical colitis caused by peracetic acid or hydrogen peroxide: a challenging dilemma. Endoscopy. 2010;42:E3–4.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Caprilli R, Viscido A, Frieri G, Latella G. Acute colitis following colonoscopy. Endoscopy. 1998;30:428–31.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of PathologyCliniques Universitaires St Luc, UCLBrusselsBelgium
  2. 2.Department of PathologyGhent University HospitalGhentBelgium
  3. 3.Department of PathologyKU LeuvenLeuvenBelgium

Personalised recommendations