Endoscopic biopsy is a test which allows the doctor to look directly at the gastrointestinal tract lining and obtain tissue samples for microscopic examination. Diagnostic endoscopic biopsy is recommended for suspected gastric cancer, lymphoma, infection confirmation and inflammatory disorders. In order to do the test, an endoscope is carefully passed through the mouth into the esophagus, stomach and duodenum or through the anus into the colon. The endoscope is a long flexible tube, about the thickness of your index finger, with a bright light at its tip. The video camera on the endoscope transmits images of the gastrointestinal tract to a monitor allowing the physician to examine the lining and identify abnormal areas. If necessary, tissue samples can be obtained through the scope during endoscopic biopsy for microscopic examination. Multiple biopsies can be taken during the procedure to increase diagnostic accuracy.

Diagnosis

Endoscopic biopsy can help doctors diagnose the reasons for

• Suspected gastric cancer or ulcers

• Suspicious lesions or nodules on endoscopy

• Chronic inflammation or ulceration

• Diagnosis of gastric lymphoma or malignancy

• H. pylori infection confirmation

• Celiac disease or tropical sprue assessment

• Inflammatory bowel disease confirmation

• Diagnosis and staging of gastrointestinal malignancy

Endoscopic biopsy can also determine the exact nature of lesions seen during endoscopy. The procedure is used to confirm diagnosis of cancer, infections, and inflammatory conditions. The doctor can also take multiple samples from different sites during endoscopic biopsy. The procedure allows the pathologist to later examine the tissue with a microscope for signs of disease, malignancy, or infection.

Rapid urease test: Biopsy tissue is tested immediately during endoscopy that will help to diagnose H. pylori infection in real time especially in patients with peptic ulcer disease or chronic gastritis.

Immunohistochemistry: is a modality when applied with endoscopic biopsy tissue can help to identify specific cell markers and confirm diagnosis of lymphoma or malignancy so that treatment planning is accurate.

Treatment

Endoscopic biopsy can help doctors with the following issues

• Confirmation of gastric cancer diagnosis for surgical planning

• Identification of lymphoma type for chemotherapy selection

• Detection of H. pylori infection for eradication therapy

• Diagnosis of celiac disease for dietary management

• Confirmation of inflammatory bowel disease for appropriate treatment

• Assessment of dysplasia severity in Barrett’s esophagus

• Staging of gastrointestinal malignancy for treatment selection

• Identification of infectious organisms for targeted antimicrobial therapy

Interventions

Multiple site biopsy: tissue samples obtained from multiple areas to increase diagnostic accuracy

Targeted biopsy: biopsy obtained from specific abnormal areas identified during endoscopy

Rapid urease test: immediate H. pylori detection performed during endoscopy for real-time diagnosis

Brush biopsy: gentle brushing technique used for fragile or bleeding lesions

Large piece biopsy: adequate tissue obtained for comprehensive histopathology analysis

Immunohistochemistry staining: special staining performed on tissue for marker identification

Flow cytometry: tissue analysis for hematologic malignancy detection

Culture biopsy: tissue cultured for identification of organisms and antibiotic susceptibility

Preventive

Gastric cancer screening biopsy: gastric cancer is common in Asian countries. Biopsy is recommended in high-risk patients with suspicious lesions to confirm diagnosis in the early stage which may help in endoscopic treatment avoiding surgery.

Surveillance biopsy in Barrett’s esophagus: Patients with long-standing Barrett’s esophagus are prone to develop esophageal cancer which can be screened by endoscopy combined with targeted biopsy from areas of dysplasia.

Early detection and diagnosis of premalignant lesions followed by treatment: Early biopsy confirmation of premalignant lesions allows appropriate intervention to prevent malignant transformation.

Infectious disease biopsy diagnosis: Patients with suspected infectious colitis, gastritis or malabsorption can be diagnosed by endoscopic biopsy identifying specific organisms for targeted treatment.