Tissue Is Often Retained in the Cap or Channel After EGD and Colonoscopy With Biopsy
Douglas K. Rex, MD, MASGE, reviewing Toy G, et al. Endosc Int Open 2023 May 23.
This study looked at retained tissue in the endoscope after EGD and colonoscopy in which only cold forceps biopsies were performed. The study cases were the consecutive colonoscopies and EGDs in which biopsy samples were obtained, and the controls were the consecutive cases with no biopsies performed. All biopsy specimens were obtained with the Radial Jaw 4 large capacity or jumbo forceps (Boston Scientific, Marlborough, Mass).
Immediately after the procedure, the rubber cap on the accessory channel was removed and inspected for tissue, followed by inspection and brushing of the accessory channel opening. Then the channel was flushed and brushed for tissue.
Retained tissue was found in 58% of cases performed with EGD and biopsy and 36% of colonoscopies with biopsies versus none of the control cases. Among those cases with retained tissue identified, 88% had tissue in the cap, 60% in the channel, and 48% in both. EGD cases were more likely to have retained tissue in the cap only, whereas tissue found just in the channel was more likely to occur after colonoscopies.
Of 50 cases with retained tissue in the endoscope, only 5 had a new or different pathologic diagnosis on the interpretation of the retained biopsy specimens. In 4 cases, the diagnosis was not clinically significant, but one had intestinal metaplasia only in the retained tissue, which would have changed the endoscopic surveillance interval if found in a biopsy specimen instead.
COMMENTThis is an interesting new finding, although the overall clinical significance is currently uncertain. Solutions would include retrieving this retained tissue or, perhaps easier, just taking enough biopsy samples to secure the correct diagnosis.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Toy G, Colletier K, Hale G, et al. Incidence of retained biopsy specimens after esophagogastroduodenoscopy and colonoscopy. Endosc Int Open 2023 May 23. (Epub ahead of print) (http://dx.doi.org/10.1055/a-2098-2470)
