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Simpler endoscopic biopsy procedure improves care, cuts provider stress
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Single-pass multiple biopsy yields results comparable to traditional endoscopic forceps biopsy while providing faster diagnosis and reducing stress for patients and providers, according to new research published in Gastrointestinal Endoscopy.
“Multibiopsy transforms endoscopic biopsy by removing the majority of manual labor and exposure to toxic fixatives, sharps and infectious material, and also facilitates histopathologic processing in pathology,” David S. Zimmon, MD, of New York Presbyterian Lower Manhattan Hospital, said in a GI Endoscopy video interview. “Current manual biopsy procedures are untenable in the face of resistant bacteria and the demands for shorter, more efficient procedures, increased productivity and reduced cost.”
With traditional endoscopic forceps biopsy, individual specimens are removed and each placed in a fixative vial, and once sent to pathology, specimens from each site are filtered to remove fixative, inspected to record specimen number and size, and then transferred to a container for processing before being mounted on slides and examined. This is a “long, complex, and costly protocol” that can be labor intensive, prolong the procedure and anesthesia, and cause ergonomic stress and workplace risks for staff, Zimmon and colleagues wrote, adding that “integrating the procedures from biopsy to slide would speed diagnosis, improve patient care, and increase productivity.”
Thus, the endoscopic multiple biopsy “addresses these problems by collecting up to 33 biopsies in a single pass through the endoscope,” Zimmon said in the video. “The technology is like a needle biopsy in that it cuts biopsies at a precise size and depth, avoiding the difficulties of the forceps scrape biopsies that are often inadequate, not deep enough, or too deep, and get lost or destroyed in processing. The biopsies are stacked like coins in the perforated metal tip of the multibiopsy in the order of acquisition [and] the last biopsy closes the metal tip so that biopsies are not lost or contaminated on withdrawal, and the staff is protected from the sharp biopsy tip.”
The tip is then cut off, immersed in fixative and sent to pathology, where the design of the plastic storage chamber inside speeds processing and diagnosis.
To compare these methods, investigators performed a blinded retrospective study of 125 colon surveillance biopsies collected from 15 patients who underwent MB and 15 who underwent forceps biopsies performed on the same day.
They found no significant differences between MB and forceps biopsy specimens regarding depth, orientation, fixation, artifacts and diagnostic information. While MB specimens were significantly smaller (26%), they showed better epithelial preservation than the forceps biopsy specimens. Finally, they found each biopsy saved 61 seconds during withdrawal.
“This preliminary report presents a means for reducing biopsy sample handling and risk in both endoscopy and pathology with a rapid seamless progression from MB and fixation to processing and microtomy to the diagnostic slide,” Zimmon and colleagues concluded. “This initial success warrants more studies to meet demands for increased productivity and better patient care at reduced cost.” – by Adam Leitenberger
Disclosures: Zimmon reports he is president and stockholder of ZKZ Science Corporation, chairman and stockholder of Curlew Endoscopy Instrument Corporation, and the inventor and patent holder of the Multiple Biopsy.
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