Korean J Intern Med.  2009 Jun;24(2):101-105. 10.3904/kjim.2009.24.2.101.

Diagnostic Yield of Tissue Sampling Using a Bite-On-Bite Technique for Incidental Subepithelial Lesions

• Ji JS
• Lee BI
• Choi KY
• Kim BW
• Choi H
• Huh M
• Chung WC
• Chae HS
• Chung IS

• KMID: 1717959
• DOI: http://doi.org/10.3904/kjim.2009.24.2.101

Abstract

BACKGROUND/AIMS: Techniques for endoscopic evaluation of gastrointestinal subepithelial lesions include conventional endoscopy, jumbo biopsy, endoscopic ultrasonogrphy (EUS), EUS-guided fine needle aspiration, and endoscopic submucosal resection. However, these procedures have many limitations, such as low diagnostic yields and high complication rates. We therefore evaluated the diagnostic yield for tissue sampling of incidental subepithelial lesions using the bite-on-bite technique.
METHODS
One hundred and forty subepithelial lesions were found in 129 patients during conventional diagnostic esophagogastroduodenoscopy by one examiner from October 2003 to November 2004. Bite-on-bite biopsies with conventional-sized forceps were taken from 36 patients having 37 lesions that did not appear to be hypervascular or to have a thick overlying epithelium. Two to eight bites were performed to obtain submucosal tissue for one lesion.
RESULTS
The bite-on-bite technique was diagnostic in 14 of the 37 lesions (38%). Blood oozing for more than 30 seconds occurred in five cases, but was easily controlled by epinephrine injection (2 cases) or hemoclip (3 cases). The diagnostic yield tended to be higher in the esophagus than in the stomach and duodenum (54% vs. 28%, p=0.109).
CONCLUSIONS
The bite-on-bite technique for subepithelial lesions is an effective and safe method in selected cases. This technique may be useful for incidental subepithelial lesions, especially those of the esophagus, except for ones with a high risk of bleeding or thick overlying epithelium.

Keyword

Subepithelial lesion; Biopsy; Endoscopy, Gastrointestinal; Endoscopic ultrasonogrphy

MeSH Terms

Adult
Aged
Biopsy/adverse effects/instrumentation/*methods
Duodenum/*pathology
*Endoscopy, Digestive System/adverse effects
Esophagus/*pathology
Female
Gastric Mucosa/pathology
Hemorrhage/etiology/prevention & control
Hemostatic Techniques
Humans
*Incidental Findings
Intestinal Mucosa/pathology
Male
Middle Aged
Predictive Value of Tests
Prospective Studies
Stomach/*pathology
Surgical Instruments