why do they take biopsies during an endoscopy

The best way to get tissue samples from the stomach is through a procedure called an. ItБs more commonly known as an endoscopy or EGD. This is generally done as an outpatient procedure. YouБll be instructed to stop eating and drinking for about 6 to 12 hours before the procedure. YouБll also be advised to stop taking blood-thinning medications. Make sure you get specific instructions from your doctor based on your medical condition. Dentures or partials must be removed. A nurse inserts an intravenous line (IV) into your vein for medications. You then are given a sedative, a painkiller, and a local anesthetic in your mouth to prevent coughing and gagging. You also need to wear a mouth guard to protect your teeth and the endoscope. During the procedure, you lie on your left side. Your doctor inserts the endoscope down your throat, through your esophagus, and into your stomach and upper small intestine. Air is pumped into the endoscope to help your doctor see clearly. Your doctor next performs a visual inspection and takes tissue samples for biopsy and culture.


The procedure takes about 5 to 20 minutes, and the samples are sent to a lab for examination. The results will be sent to your doctor for review. You must refrain from eating and drinking until your gag reflex returns. Your throat may feel a little sore, and you might feel gas and bloating because of the air in the endoscope. These side effects will wear off shortly, and youБll be able to return home the same day.
A reader recently wrote to ask about whether physicians usually do biopsies during an upper endoscopy. He didnt realize he was asking a loaded question! Heres my take on the question. Learn more In a patient undergoing endoscopy for suspectedPesophageal disease, includingP adenocarcinoma prognosis, aP 1. When there is any visible focalPabnormality in the esophagusP(stricture, mass, ulcer, erythema,Pinlet patch, web, Schatzki ring, etc. ) Most GIs will do this, although the thoroughness of the biopsies varies greatly.


The diagnosis is more likely to be accurate when the biopsy is thorough. Learn more 2. In patients with a visible columnar lined esophagus without any focal lesions. The recommendation is that biopsies be taken at intervals of 1-2 cm (four quadrant biopsies from each level) from the squamocolumnar junction to the end of the esophagus. This recommendation is rarely followed. Most GIs will take a few random biopsies from all over and submit them all in one bottle. This is not appropriate. Endoscopy is a significant procedure for a patient. A thorough job with biopsies increases the probability of an accurate diagnosis anything less is substandard care. So why arent GIs always thorough? (a) Biopsies are time consuming and increase the duration of the procedure and (b) The reimbursement for endoscopy with biopsy does not change with number of biopsies taken. What if the esophagus looks normal? The American Gastroenterological Association (AGA) recommends that patients who are endoscopically normal should not undergo biopsy.


The majority of GIs who do endoscopy follow this recommendation; however, this recommendation is difficult to understand. Most GIs will say that if they take a biopsy of a GERD patient who is endoscopically normal, approximately 10% will have intestinal metaplasia. Everyone recognizes that this is abnormal, and almost everyone will agree that this is likely the precursor of cancer in this regionP. The actual Por for an adenocarcinoma prognosis with this finding is unknown and likely to be small. PThe reason they will give for not taking biopsies is that they do not know what to do with the finding if there is intestinal metaplasia. This is a classic catch-22 situation:P I will not biopsy because I do not know what to do with the patient if they have intestinal metaplasia. I will never know the significance of intestinal metaplasia if I do not biopsy. I strongly believe biopsies should be taken at the squamo-columnar junction in GERD patients who do not have an endoscopic abnormality.


This would help us catch pre-cancerous changes in their earliest stages. The challenge, then, is what to do if a patient has intestinal metaplasia. While periodic surveillance is the norm for patients diagnosed with (intestinal metaplasia AND visible abnormality), there isnt a clear standard for surveillance of intestinal metaplasia without visible abnormality. If you have a biopsy and learn you have intestinal metaplasia, youll need to discuss your options and make an informed decision together with your doctor. Endoscopic surveillance is costly and may not be justified on the basis of cost-effectiveness in the entire population. However, if you are worried about even a small cancer risk, this maybe appropriate. In some cases, you may be asked to pay for the surveillance if your insurer refuses to cover the cost. This may change your mind, but it has to be your choice.

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