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Endoscopic Instruments and Techniques Used by Gastroenterologists: A Primer for Pathologists

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Surgical Pathology of the Gastrointestinal System
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Abstract

The investigations and management of patients with gastrointestinal (GI) diseases have been revolutionized with the advent of video-endoscope. Gastrointestinal endoscopic examinations are meant for visualization and examination of the GI lumen and mucosal surfaces, and it includes real-time interpretation of abnormalities and its management. Due to advancements in optics technology and computation, endoscopic instruments and techniques have improved dramatically from the fiber-optic endoscope to video-endoscope. Advancement in biomedical engineering leads to improvement in endoscopic design and image acquisition, accessories, and instruments; therefore, various advance diagnostic and therapeutic procedures are being done endoscopically, which were previously unthinkable.

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References

  1. ASGE Technology Committee, Varadarajulu S, Banerjee S, Barth BA, Desilets DJ, Kaul V, et al. GI endoscopes. Gastrointest Endosc. 2011;74(1):1–6.e6.

    Article  Google Scholar 

  2. ASGE Technology Committee, Kwon RS, Adler DG, Chand B, Conway JD, Diehl DL, et al. High-resolution and high-magnification endoscopes. Gastrointest Endosc. 2009;69(3 Pt 1):399–407.

    Google Scholar 

  3. East JE, Vleugels JL, Roelandt P, Bhandari P, Bisschops R, Dekker E, et al. Advanced endoscopic imaging: European Society of Gastrointestinal Endoscopy (ESGE) Technology Review. Endoscopy. 2016;48(11):1029–45.

    Article  PubMed  Google Scholar 

  4. Dolwani S, Saleem H, Thompson IW, Allison MC. A comparison of three types of biopsy forceps in the endoscopic surveillance of Barrett’s oesophagus. Endoscopy. 2002;34(12):946–9.

    Article  CAS  PubMed  Google Scholar 

  5. Zaidman JS, Frederick WG, Furth EE, Su CG, Ginsberg GG. Comparison of Pelican single-use multibite biopsy forceps and traditional double-bite forceps: evaluation in a porcine model. Gastrointest Endosc. 2006;64(4):582–8.

    Article  PubMed  Google Scholar 

  6. Gonzalez S, Yu WM, Smith MS, Slack KN, Rotterdam H, Abrams JA, et al. Randomized comparison of 3 different-sized biopsy forceps for quality of sampling in Barrett’s esophagus. Gastrointest Endosc. 2010;72(5):935–40.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Martinek J, Maluskova J, Stefanova M, Tuckova I, Suchanek S, Vackova Z, et al. Improved specimen adequacy using jumbo biopsy forceps in patients with Barrett’s esophagus. World J Gastroenterol. 2015;21(17):5328–35.

    Article  PubMed  PubMed Central  Google Scholar 

  8. O’Donoghue JM, Horgan PG, O’Donohoe MK, Byrne J, O’Hanlon DM, McGuire M, et al. Adjunctive endoscopic brush cytology in the detection of upper gastrointestinal malignancy. Acta Cytol. 1995;39(1):28–34.

    PubMed  Google Scholar 

  9. Mariano VS, Pastrez PRA, Mafra Costa A, Guimarães DP, Cunha TR, Neto SAZ, et al. Impact of brush cytology analysis for the diagnosis of esophageal squamous cell carcinoma: the quality of liquid-based preparation of cytological slides. Acta Cytol. 2019;63(3):240–6.

    Article  PubMed  Google Scholar 

  10. Navaneethan U, Njei B, Lourdusamy V, Konjeti R, Vargo JJ, Parsi MA. Comparative effectiveness of biliary brush cytology and intraductal biopsy for detection of malignant biliary strictures: a systematic review and meta-analysis. Gastrointest Endosc. 2015;81(1):168–76.

    Article  PubMed  Google Scholar 

  11. Technology Assessment Committee, Croffie J, Somogyi L, Chuttani R, DiSario J, Liu J, et al. Sclerosing agents for use in GI endoscopy. Gastrointest Endosc. 2007;66(1):1–6.

    Article  Google Scholar 

  12. de Moura DTH, McCarty TR, Jirapinyo P, Ribeiro IB, Flumignan VK, Najdawai F, et al. EUS-guided fine-needle biopsy versus fine-needle aspiration in the diagnosis of subepithelial lesions: a large multicenter study. Gastrointest Endosc. 2020;92:108–19.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Grassia R, Imperatore N, Capone P, Cereatti F, Forti E, Antonini F, et al. EUS-guided tissue acquisition in chronic pancreatitis: differential diagnosis between pancreatic cancer and pseudotumoral masses using EUS-FNA or core biopsy. Endosc Ultrasound. 2020;9(2):122–9.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ang TL, Li JW, Kwek ABE, Thurairajah PH, Wang LM. The difference in histological yield between 19G EUS-FNA and EUS-fine-needle biopsy needles. Endosc Ultrasound. 2019;8(4):255–60.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Rey JF, Beilenhoff U, Neumann CS, Dumonceau JM. European Society of Gastrointestinal Endoscopy (ESGE). European Society of Gastrointestinal Endoscopy (ESGE) guideline: the use of electrosurgical units. Endoscopy. 2010;42(9):764–72.

    Article  CAS  PubMed  Google Scholar 

  16. Gunjan D, Sharma V, Rana SS, Bhasin DK. Small bowel bleeding: a comprehensive review. Gastroenterol Rep (Oxf). 2014;2(4):262–75.

    Article  Google Scholar 

  17. Beyna T, Arvanitakis M, Schneider M, Gerges C, Böing D, Devière J, et al. Motorised spiral enteroscopy: first prospective clinical feasibility study. Gut [Internet]. 2020 [cited 2020 Apr 28]. Available from: https://gut.bmj.com/content/early/2020/04/24/gutjnl-2019-319908.

  18. Singla V, Garg PK. Role of diagnostic and therapeutic endoscopic ultrasonography in benign pancreatic diseases. Endosc Ultrasound. 2013;2(3):134–41.

    Article  PubMed  PubMed Central  Google Scholar 

  19. ASGE Technology Committee, Komanduri S, Thosani N, Abu Dayyeh BK, Aslanian HR, Enestvedt BK, et al. Cholangiopancreatoscopy. Gastrointest Endosc. 2016;84(2):209–21.

    Article  Google Scholar 

  20. ASGE Standards of Practice Committee, Saltzman JR, Cash BD, Pasha SF, Early DS, Muthusamy VR, et al. Bowel preparation before colonoscopy. Gastrointest Endosc. 2015;81(4):781–94.

    Article  Google Scholar 

  21. Malfertheiner P, Megraud F, O’Morain CA, Gisbert JP, Kuipers EJ, Axon AT, et al. Management of Helicobacter pylori infection—the Maastricht V/Florence Consensus Report. Gut. 2017;66(1):6–30.

    Article  CAS  PubMed  Google Scholar 

  22. Facciorusso A, Sunny SP, Del Prete V, Antonino M, Muscatiello N. Comparison between fine-needle biopsy and fine-needle aspiration for EUS-guided sampling of subepithelial lesions: a meta-analysis. Gastrointest Endosc. 2020;91(1):14–22.e2.

    Article  PubMed  Google Scholar 

  23. Wang HH, Sovie S, Zeroogian JM, Spechler SJ, Goyal RK, Antonioli DA. Value of cytology in detecting intestinal metaplasia and associated dysplasia at the gastroesophageal junction. Hum Pathol. 1997;28(4):465–71.

    Article  CAS  PubMed  Google Scholar 

  24. Muniraj F, Siddaraju N, Sistla SC. Role of brush cytology in the diagnosis of neoplastic and non-neoplastic upper gastrointestinal lesions. Cytopathology. 2016;27(6):407–17.

    Article  CAS  PubMed  Google Scholar 

  25. Zargar SA, Khuroo MS, Jan GM, Mahajan R, Shah P. Prospective comparison of the value of brushings before and after biopsy in the endoscopic diagnosis of gastroesophageal malignancy. Acta Cytol. 1991;35(5):549–52.

    CAS  PubMed  Google Scholar 

  26. Keighley MR, Thompson H, Moore J, Hoare AM, Allan RN, Dykes PW. Comparison of brush cytology before or after biopsy for diagnosis of gastric carcinoma. Br J Surg. 1979;66(4):246–7.

    Article  CAS  PubMed  Google Scholar 

  27. Kaur S, Sharma R, Kaushal V, Gulati A, Sharma B. Diagnostic accuracy of endoscopic brush cytology in malignancies of upper gastrointestinal tract: a prospective study of 251 patients in North India. J Cancer Res Ther. 2016;12(2):681–4.

    Article  CAS  PubMed  Google Scholar 

  28. Kaur S, Sharma R, Kaushal V, Gulati A, Sharma B. The diagnostic accuracy of colonoscopic brush cytology in diagnosis of colorectal malignancies: a study of 49 patients. J Cancer Res Ther. 2018;14(3):574–7.

    Article  PubMed  Google Scholar 

  29. Geisinger KR, Teot LA, Richter JE. A comparative cytopathologic and histologic study of atypia, dysplasia, and adenocarcinoma in Barrett’s esophagus. Cancer. 1992;69(1):8–16.

    Article  CAS  PubMed  Google Scholar 

  30. Tamura K, Masuzawa M, Akiyama T, Fukui O. Touch smear cytology for endoscopic diagnosis of gastric carcinoma. Am J Gastroenterol. 1977;67(5):463–7.

    CAS  PubMed  Google Scholar 

  31. Kaur G, Madhavan M, Basri AH, Sain AHM, Hussain MSB, Yatiban MK, et al. Rapid diagnosis of Helicobacter pylori infection in gastric imprint smears. Southeast Asian J Trop Med Public Health. 2004;35(3):676–80.

    PubMed  Google Scholar 

  32. Murphy PD, Hoffman J, Karczenski C, Gilliland EL, Peel AL, Rosenberg TI. Serosal imprint cytology in colonic cancer: a simple staging technique. Int J Color Dis. 1994;9(2):96–9.

    Article  CAS  Google Scholar 

  33. Malapelle U, Bellevicine C, Russo A, Salatiello M, Palombini L, Troncone G. KRAS testing on colo-rectal carcinoma cytological imprints. Diagn Cytopathol. 2011;39(4):274–7.

    Article  PubMed  Google Scholar 

  34. Kochhar R, Bhasin DK, Rajwanshi A, Gupta SK, Malik AK, Mehta SK. Crush preparations of gastroesophageal biopsy specimens in the diagnosis of malignancy. Acta Cytol. 1990;34(2):214–6.

    CAS  PubMed  Google Scholar 

  35. Buchireddy D, Chakraborti SS, Subba SH. Crush cytology of gastrointestinal malignancy: a cytohistologic comparison. Am J Clin Pathol. 2012;138(suppl_2):A274.

    Article  Google Scholar 

  36. Gv C, Saha D, Yadav R, Adiga DS, Lobo FD, Ghosh A, et al. The role of crush cytology in the diagnosis of large-intestine lesions with correlation on histopathology. Acta Cytol. 2018;62(3):215–22.

    Article  PubMed  Google Scholar 

  37. Batra M, Handa U, Mohan H, Sachdev A. Comparison of cytohistologic techniques in diagnosis of gastroesophageal malignancy. Acta Cytol. 2008 Feb;52(1):77–82.

    Article  PubMed  Google Scholar 

  38. Rana A, Rana SS. Endoscopic ultrasound-guided tissue acquisition: techniques and challenges. J Cytol. 2019;36(1):1–7.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Wani S. Basic techniques in endoscopic ultrasound-guided fine-needle aspiration: role of a stylet and suction. Endosc Ultrasound. 2014;3(1):17–21.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Li H, Li W, Zhou Q-Y, Fan B. Fine needle biopsy is superior to fine needle aspiration in endoscopic ultrasound guided sampling of pancreatic masses. Medicine (Baltimore) [Internet]. 2018 [cited 2020 May 6];97(13). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5895392/.

  41. Bick BL, Enders FT, Levy MJ, Zhang L, Henry MR, Abu Dayyeh BK, et al. The string sign for diagnosis of mucinous pancreatic cysts. Endoscopy. 2015;47(7):626–31.

    Article  PubMed  Google Scholar 

  42. Gillis A, Cipollone I, Cousins G, Conlon K. Does EUS-FNA molecular analysis carry additional value when compared to cytology in the diagnosis of pancreatic cystic neoplasm? A systematic review. HPB (Oxford). 2015;17(5):377–86.

    Article  Google Scholar 

  43. Elta GH, Enestvedt BK, Sauer BG, Lennon AM. ACG clinical guideline: diagnosis and management of pancreatic cysts. Am J Gastroenterol. 2018;113(4):464–79.

    Article  PubMed  Google Scholar 

  44. Kipp BR, Stadheim LM, Halling SA, Pochron NL, Harmsen S, Nagorney DM, et al. A comparison of routine cytology and fluorescence in situ hybridization for the detection of malignant bile duct strictures. Am J Gastroenterol. 2004;99(9):1675–81.

    Article  PubMed  Google Scholar 

  45. Jain D, Mathur SR, Iyer VK. Cell blocks in cytopathology: a review of preparative methods, utility in diagnosis and role in ancillary studies. Cytopathology. 2014;25(6):356–71.

    CAS  PubMed  Google Scholar 

  46. ASGE Technology Committee, Wong Kee Song LM, Adler DG, Chand B, Conway JD, Croffie JMB, et al. Chromoendoscopy. Gastrointest Endosc. 2007;66(4):639–49.

    Article  Google Scholar 

  47. ASGE Technology Committee, Manfredi MA, Abu Dayyeh BK, Bhat YM, Chauhan SS, Gottlieb KT, et al. Electronic chromoendoscopy. Gastrointest Endosc. 2015;81(2):249–61.

    Article  Google Scholar 

  48. Song L-MWK, Banerjee S, Desilets D, Diehl DL, Farraye FA, Kaul V, et al. Autofluorescence imaging. Gastrointest Endosc. 2011;73(4):647–50.

    Article  PubMed  Google Scholar 

  49. ASGE Technology Committee. Confocal laser endomicroscopy. Gastrointest Endosc. 2014;80(6):928–38.

    Article  Google Scholar 

  50. Curvers WL, Singh R, Song L-MW-K, Wolfsen HC, Ragunath K, Wang K, et al. Endoscopic tri-modal imaging for detection of early neoplasia in Barrett’s oesophagus: a multi-centre feasibility study using high-resolution endoscopy, autofluorescence imaging and narrow band imaging incorporated in one endoscopy system. Gut. 2008;57(2):167–72.

    Article  CAS  PubMed  Google Scholar 

  51. Le Berre C, Sandborn WJ, Aridhi S, Devignes M-D, Fournier L, Smaïl-Tabbone M, et al. Application of artificial intelligence to gastroenterology and hepatology. Gastroenterology. 2020;158(1):76–94.e2.

    Article  PubMed  Google Scholar 

  52. Kothari ST, Huang RJ, Shaukat A, Agrawal D, Buxbaum JL, Fehmi SMA, et al. ASGE review of adverse events in colonoscopy. Gastrointest Endosc. 2019;90(6):863–876.e33.

    Article  PubMed  Google Scholar 

  53. ASGE Standards of Practice Committee, Ben-Menachem T, Decker GA, Early DS, Evans J, Fanelli RD, et al. Adverse events of upper GI endoscopy. Gastrointest Endosc. 2012;76(4):707–18.

    Article  Google Scholar 

  54. Wang K-X, Ben Q-W, Jin Z-D, Du Y-Q, Zou D-W, Liao Z, et al. Assessment of morbidity and mortality associated with EUS-guided FNA: a systematic review. Gastrointest Endosc. 2011;73(2):283–90.

    Article  PubMed  Google Scholar 

  55. Geramizadeh B, Owen DA. Handling and pathology reporting of gastrointestinal endoscopic mucosal resection. Middle East J Dig Dis. 2017;9(1):5–11.

    Article  PubMed  PubMed Central  Google Scholar 

  56. de Moura DTH, Aihara H, Thompson CC. Robotic-assisted surgical endoscopy: a new era for endoluminal therapies. VideoGIE. 2019;4(9):399–402.

    Article  Google Scholar 

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Disclaimer

The authors agree to the fact that all biopsy procedures and surgical resections were performed after taking informed consent from respective patients as per the individual Institutional policies, which also includes consent for publishing the unidentified clinical images for publication or research purposes. The authors also declare no conflict of interest.

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Gunjan, D., Das, P. (2022). Endoscopic Instruments and Techniques Used by Gastroenterologists: A Primer for Pathologists. In: Das, P., Majumdar, K., Datta Gupta, S. (eds) Surgical Pathology of the Gastrointestinal System. Springer, Singapore. https://doi.org/10.1007/978-981-16-6395-6_3

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  • DOI: https://doi.org/10.1007/978-981-16-6395-6_3

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