Impact of Preresection Biopsy on Subsequent Endoscopic Mucosal Resection

COMMENT

The poor sensitivity of preresection biopsy for cancer probably reflects referral bias because preresection biopsies that diagnosed cancer would lead to surgical referral rather than endoscopic resection. Having said that, the only rational reason to perform preresection biopsy is to identify cancer, and the real question is how often cancer is identified by a preresection biopsy when there is no overt endoscopic evidence of cancer. This study can’t answer that question, but the likely answer is “almost never.”

This study does suggest that preresection biopsy of benign-appearing laterally spreading lesions produces some problems for EMR, including submucosal fibrosis and increased intraprocedural bleeding. Overall, the study supports the recommendation to not perform a biopsy of laterally spreading lesions unless there is overt evidence of cancer. It indirectly supports the common admonition to avoid performing biopsies of flat areas and the edges of lesions, which are more likely to lead to significant submucosal fibrosis. This could alter the subsequent resection approach compared to biopsy of bulky or sessile portions of the lesion.