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Endoscopic multiple biopsy and rapid diagnosis by in situ fixation and histopathologic processing

Zimmon, David S; Smith, Fred B; Manheimer, Forrest; Fan, Cathy; Njiwaji, Chantel; Aksenov, Sergei; Chattoo, Premtesh
BACKGROUND AND AIMS/OBJECTIVE:Endoscopic forceps biopsy and fixation are laborious and prolong the procedure and anesthesia. Multiple biopsy overcomes these shortcomings with a single endoscope pass that cuts, like a needle biopsy, up to 25 biopsy samples of uniform size and depth during endoscope withdrawal. Biopsy specimens are collected in acquisition order and stored in a perforated plastic storage chamber within the perforated metal tip. The tip is cut off, immersed in fixative, and sent to pathology. A formatted log identifies each biopsy specimen by site and position. In pathology, the plastic storage cylinder, designed for processing and microtomy with biopsy specimens in situ, supports rapid diagnosis by frozen section and microwave or routine paraffin processing. METHODS:After a 10-patient Institutional Review Board safety study and US Food and Drug Administration registration, biopsies were performed in 57 patients during colonoscopy, upper GI endoscopy, and ERCP. A blinded retrospective study compared colon surveillance biopsies in 15 patients who underwent multiple biopsy with 15 patients who underwent forceps biopsies performed by anonymous physicians on the same day. Patient information was removed from slides, and forceps biopsies were oriented manually for blinding. RESULTS:Multiple biopsy specimens fixed and processed in situ were not significantly different from batched processed forceps biopsy specimens for depth, orientation, fixation, artifacts, and diagnostic information. Multiple biopsy colonic specimens were significantly (26%) smaller with better epithelial preservation than forceps specimens. Each biopsy saves 61 seconds during withdrawal. CONCLUSIONS:Single-pass multiple biopsy reduces biopsy time with less specimen damage, work, workplace risk, and soiling. Diagnostic quality is equal to forceps biopsy with better epithelial preservation, although 26% smaller. In pathology, in situ processing and microtomy reduce work and workplace risk. Grossing and manual orientation are unnecessary. Rapid diagnosis by frozen section and microwave or paraffin processing are facilitated. Multiple biopsy speeds diagnosis and improves productivity in endoscopic biopsy and histopathologic processing.
PMID: 27988287
ISSN: 1097-6779
CID: 3095612

Papillotomy or sphincterotomy--new or old? [Letter]

Zimmon, David S
PMID: 18513568
ISSN: 1097-6779
CID: 94127

Endoscopic multibiopsy with serial collection, storage and processing of specimens in situ [Meeting Abstract]

Zimmon, D
ISI:000252145700103
ISSN: 1078-0998
CID: 75958

Esophageal biopsy: apples and oranges [Letter]

Zimmon, David S
PMID: 12447328
ISSN: 0016-5107
CID: 65291

The hemodynamics of vascular obliteration in cirrhosis; Segmental hepatic lobular hypertension-the third hit [Meeting Abstract]

Zimmon, DS; Manheimer, F
ISI:000178301702204
ISSN: 0270-9139
CID: 36614

Segmental variation of wedged hepatic venous pressure in individual cirrhotic patients with portal hypertension: hemodynamic evidence of the second hit [Meeting Abstract]

Zimmon David S; Manheimer Forrest
BIOABSTRACTS:200100340094
ISSN: 0270-9139
CID: 26884

Blind beta blockade [Letter]

Zimmon DS; Manheimer F
PMID: 11584387
ISSN: 0270-9139
CID: 65292

(Untitled)

Zimmon, David S.; Manheimer, Forrest
BIOABSTRACTS:BACD200100340094
ISSN: 0270-9139
CID: 98794

Pumping portal blood for therapy and knowledge [Editorial]

Zimmon DS
PMID: 8836909
ISSN: 0168-8278
CID: 65293

Endoscopic esophagogastric balloon tamponade [Case Report]

Zimmon DS
PMID: 7859973
ISSN: 0016-5107
CID: 65294