Hospices Civils de Lyon, Hôpital Edouard Herriot, Fédération des Spécialités Digestives, Villeurbanne, France.
J Clin Gastroenterol. 2010 Jan;44(1):12-7. doi: 10.1097/MCG.0b013e3181a1bebd.
Esophagogastroduodenoscopy (EGD) can be routinely performed via a nasal route in adults by using small-caliber endoscopes. The aim of this study was to evaluate the adequacy of biopsy specimens obtained with small forceps for histologic diagnosis.
From January to April 2007, we prospectively compared all biopsy specimens obtained, during conventional EGD (8.8-mm-diameter endoscope), with (CS-EGD) or without sedation (C-EGD), and transnasal or transoral-EGD (4.9-mm-diameter endoscope) without sedation (T-EGD). All biopsy specimens were blindly evaluated by a pathologist. For each specimen, were recorded: site, biopsy size and thickness, type of lesion (focal or diffuse), and in case of focal abnormalities described by the endoscopist, presence of the histologic lesions in the targeted biopsies.
One thousand and thirty-five biopsy specimens were obtained from 300 procedures (109 T-EGD, 48 C-EGD, and 143 CS-EGD): 983 biopsy specimens were untargeted (esophagus and cardia in 21%, stomach in 85% and duodenum in 84%) and 352 biopsy specimens were targeted to focal lesions (esophagus and cardia in 79%, stomach in 15%, and duodenum in 16%). The mean size of specimens was 1.8, 2, 2.2 mm diameter, in T-EGD, C-EGD, and CS-EGD groups, respectively (P<0.001). The whole thickness of mucosa was present in 68%, 84%, 71% of the cases among T-EGD, C-EGD, and CS-EGD groups, respectively (P=0.9). There was no significant difference in the rate of definitive histologic diagnosis from targeted or nontargeted biopsies according to the endoscopic procedure.
Biopsy specimens obtained during EGD with small forceps are as effective for diagnosis as those obtained with standard forceps.
食管胃十二指肠镜检查（EGD）可通过使用小口径内镜经鼻常规进行。本研究的目的是评估使用小活检钳获得的活检标本进行组织学诊断的充分性。
2007 年 1 月至 4 月，我们前瞻性比较了所有在常规 EGD（8.8 毫米直径内镜）期间获得的活检标本，包括（CS-EGD）或无镇静（C-EGD），以及无镇静的经鼻或经口-EGD（4.9 毫米直径内镜）（T-EGD）。所有活检标本均由病理学家进行盲法评估。对于每个标本，记录：部位、活检大小和厚度、病变类型（局灶性或弥漫性），以及如果内镜医生描述了局灶性异常，在目标活检中是否存在组织学病变。
从 300 例手术中获得了 1035 个活检标本（109 例 T-EGD、48 例 C-EGD 和 143 例 CS-EGD）：983 个活检标本为非靶向（食管和贲门占 21%，胃占 85%，十二指肠占 84%），352 个活检标本为靶向局灶性病变（食管和贲门占 79%，胃占 15%，十二指肠占 16%）。T-EGD、C-EGD 和 CS-EGD 组标本的平均直径分别为 1.8、2 和 2.2 毫米（P<0.001）。T-EGD、C-EGD 和 CS-EGD 组中，黏膜全层存在的比例分别为 68%、84%和 71%（P=0.9）。根据内镜检查程序，靶向或非靶向活检的明确组织学诊断率无显著差异。
使用小活检钳进行 EGD 时获得的活检标本与使用标准活检钳获得的活检标本一样有效用于诊断。
