Sussman Daniel A, Deshpande Amar R, Shankar Uday, Barkin Jodie A, Medina Ana Maria, Poppiti Robert J, Cubeddu Luigi X, Barkin Jamie S
Division of Gastroenterology, Department of Medicine, Leonard M. Miller School of Medicine, University of Miami, 1120 NW 14th Street, Clinical Research Building, Suite 1116, Miami, FL, 33136, USA.
Aventura Hospital and Medical Center, Aventura, FL, 33180, USA.
Dig Dis Sci. 2016 Aug;61(8):2338-2343. doi: 10.1007/s10620-016-4129-y. Epub 2016 Mar 22.
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.
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.
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.
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).
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.
获取高质量的内镜活检标本对于成功进行组织学诊断至关重要。活检钳杯状形状和大小对活检标本质量的影响尚不清楚。
确定椭圆形杯状活检钳或两种不同锯齿状钳口活检钳是否能获取更大尺寸的标本。次要终点为组织充足性、组织获取深度和挤压伪像。
进行了一项单中心、前瞻性、病理学家设盲的随机对照试验。总共136例有食管胃十二指肠镜检查及活检临床指征的患者被随机分为两组，分别接受钳口直径2.2毫米的大容量锯齿状钳（SER1）与钳口直径2.4毫米的大容量椭圆形钳（OVL）或钳口直径2.4毫米的大容量锯齿状活检钳（SER2）进行系列活检。
SER2获取的标本明显大于其他活检钳（SER2 3.26±1.09，SER1 2.92±0.88，OVL 2.92±0.76；p = 0.026），与SER1和OVL相比，SER2的平均尺寸差异大0.34毫米。与SER1和SER2相比，OVL获取的活检深度明显更深（p = 0.02），31%的OVL活检到达黏膜下层。SER2的挤压伪像明显少于SER1和OVL（p < 0.0001）。
与相同尺寸的椭圆形钳口活检钳相比，锯齿状钳获取的样本更大，SER2获取的标本尺寸最大。椭圆形杯状活检钳对上皮的穿透更深，而钳口直径较大的锯齿状钳口活检钳挤压伪像更少。所有三种活检钳获取的标本均足以用于诊断目的。
