Departments of Medicine, Columbia University Medical Center, New York, New York, USA.
Gastrointest Endosc. 2010 Nov;72(5):935-40. doi: 10.1016/j.gie.2010.07.035.
Several types of forceps are available for use in sampling Barrett's esophagus (BE). Few data exist with regard to biopsy quality for histologic assessment.
To evaluate sampling quality of 3 different forceps in patients with BE.
Single-center, randomized clinical trial.
Consecutive patients with BE undergoing upper endoscopy.
Patients randomized to have biopsy specimens taken with 1 of 3 types of forceps: standard, large capacity, or jumbo.
Specimen adequacy was defined a priori as a well-oriented biopsy sample 2 mm or greater in diameter and with at least muscularis mucosa present.
A total of 65 patients were enrolled and analyzed (standard forceps, n = 21; large-capacity forceps, n = 21; jumbo forceps, n = 23). Compared with jumbo forceps, a significantly higher proportion of biopsy samples with large-capacity forceps were adequate (37.8% vs 25.2%, P = .002). Of the standard forceps biopsy samples, 31.9% were adequate, which was not significantly different from specimens taken with large-capacity (P = .20) or jumbo (P = .09) forceps. Biopsy specimens taken with jumbo forceps had the largest diameter (median, 3.0 mm vs 2.5 mm [standard] vs 2.8 mm [large capacity]; P = .0001). However, jumbo forceps had the lowest proportion of specimens that were well oriented (overall P = .001).
Heterogeneous patient population precluded dysplasia detection analyses.
Our results challenge the requirement of jumbo forceps and therapeutic endoscopes to properly perform the Seattle protocol. We found that standard and large-capacity forceps used with standard upper endoscopes produced biopsy samples at least as adequate as those obtained with jumbo forceps and therapeutic endoscopes in patients with BE.
有几种类型的钳子可用于 Barrett 食管（BE）取样。关于组织学评估的活检质量，数据很少。
评估 3 种不同钳子在 BE 患者中的采样质量。
单中心、随机临床试验。
接受上消化道内镜检查的连续 BE 患者。
患者随机接受 3 种类型的钳子之一进行活检标本采集：标准、大容量或特大号。
标本充足性预先定义为直径为 2 毫米或更大且至少具有黏膜肌层的良好定向活检样本。
共纳入并分析了 65 例患者（标准钳子 21 例，大容量钳子 21 例，特大号钳子 23 例）。与特大号钳子相比，大容量钳子采集的活检样本中，充足样本的比例明显更高（37.8%比 25.2%，P=.002）。标准钳子活检样本中，充足样本的比例为 31.9%，与大容量（P=.20）或特大号（P=.09）钳子采集的样本无显著差异。特大号钳子采集的活检标本直径最大（中位数，3.0 毫米比 2.5 毫米[标准]比 2.8 毫米[大容量]；P=.0001）。然而，特大号钳子采集的标本定向良好的比例最低（总体 P=.001）。
异质患者人群排除了发育不良检测分析。
我们的结果对使用特大号钳子和治疗性内镜正确执行西雅图方案提出了挑战。我们发现，在 BE 患者中，与特大号钳子和治疗性内镜相比，使用标准内镜和大容量钳子采集的活检样本至少同样充足。
