Clin Endosc.  2017 Jan;50(1):64-68. 10.5946/ce.2015.094.

Mucosal Incision and Forceps Biopsy for Reliable Tissue Sampling of Gastric Subepithelial Tumors

• Shin SY
• Lee SJ
• Jun JH
• Park JK
• Seo HI
• Han KH
• Kim YD
• Jeong WJ
• Cheon GJ

• KMID: 2383492
• DOI: http://doi.org/10.5946/ce.2015.094

Abstract

BACKGROUND/AIMS
The diagnostic efficacy of current tissue sampling techniques for gastric subepithelial tumors (SETs) is limited. Better tissue sampling techniques are needed to improve pathological diagnosis. The aim of this study was to evaluate the safety and efficacy of a new technique, mucosal incision and forceps biopsy, for reliable tissue sampling of gastric SETs.
METHODS
This study enrolled 12 consecutive patients who underwent mucosal incision and forceps biopsy of gastric SETs between November 2011 and September 2014 at Gangneung Asan Hospital. The medical records of patients were reviewed retrospectively. The safety and diagnostic yield of this method were evaluated.
RESULTS
By performing mucosal incision and forceps biopsy, we were able to provide a definitive histological diagnosis for 11 out of 12 cases. The pathological diagnoses were leiomyoma (3/11), gastrointestinal stromal tumor (GIST; 2/11), lipoma (2/11), schwannoma (1/11), and ectopic pancreas (3/11). In cases of leiomyoma (n=3) and GIST (n=2), tissue samples were of sufficient size to allow immunohistochemical staining. In addition, the mitotic index was evaluated in two cases of GIST. There were no procedure-related complications.
CONCLUSIONS
Mucosal incision and forceps biopsy can be used as one of several methods to obtain adequate tissue samples from gastric SETs.

Keyword

Stomach; Biopsy; Gastroscopy; Diagnosis

MeSH Terms

Biopsy*
Chungcheongnam-do
Diagnosis
Gangwon-do
Gastrointestinal Stromal Tumors
Gastroscopy
Humans
Leiomyoma
Lipoma
Medical Records
Methods
Mitotic Index
Neurilemmoma
Pancreas
Retrospective Studies
Stomach
Surgical Instruments*

Figure

• 

  Fig. 1. Mucosal incision and forceps biopsy technique. (A) A 41-mm subepithelial tumor (SET) on the anterior wall of the angle of stomach. (B) Injection mixture of indigocarmine and glycerol in the SET. (C) Mucosal incision by using a hook knife. (D) Exposure of the SET through the incised mucosa. (E) Obtaining specmens by using conventional biopsy forceps. (F) Closure of the mucosal incisions with clips.

• 

  Fig. 2. Pathological findings for the biopsy specimen in a patient with schwannoma (Table 1, case 7). (A) Eight pieces of the biopsy specimen measuring 1 to 1.5 mm. (B) The biopsy specimen is composed of spindle cells (H&E stain, ×20). (C) The biopsy specimen showing reddish brown immunostaining, positive for S-100 (×20). (D) The biopsy specimen showing negative immunostaining for smooth muscle actin (SMA, ×20). (E) The biopsy specimen showing negative immunostaining for c-KIT (×20).

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