Mistakes in tissue acquisition during endoscopy and how to avoid them

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Mistakes in tissue acquisition during endoscopy and how to avoid them

Mario Dinis-Ribeiro, Rui Pedro Bastos

Summary

AI Generated

This manuscript identifies the eight most frequent and correctable mistakes in endoscopic tissue acquisition for digestive disease investigation.

Tissue sampling during endoscopic procedures is fundamental to investigating digestive diseases, with histological examination playing a crucial role in almost every case.
The potential for mistakes in tissue sampling is significant given its prevalence in gastroenterology practice.
Understanding appropriate indications, techniques, and consequences of tissue sampling is essential for gastroenterologists.
The manuscript addresses key questions clinicians should consider before biopsy: Why, What for, How, and How many.
Recommendations are largely supported by existing guidelines and evidence, supplemented by the authors' professional experience.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8

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Whitson MJ, Dikman AE, von Althann C, Sanyal S, Desai JC, Bamji ND, et al. Is gastroduodenal biopsy safe in patients receiving aspirin and clopidogrel?: a prospective, randomized study involving 630 biopsies. J Clin Gastroenterol. 2011 Mar;45(3):228–33.

Veitch AM, Radaelli F, Alikhan R, Dumonceau JM, Eaton D, Jerrome J, et al. Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update. Gut. 2021 Sep;70(9):1611–28.

ASGE Standards of Practice Committee, Acosta RD, Abraham NS, Chandrasekhara V, Chathadi K V, Early DS, et al. The management of antithrombotic agents for patients undergoing GI endoscopy. Gastrointest Endosc. 2016 Jan;83(1):3–16.

Miehlke S, Guagnozzi D, Zabana Y, Tontini GE, Kanstrup Fiehn AM, Wildt S, et al. European guidelines on microscopic colitis: United European Gastroenterology and European Microscopic Colitis Group statements and recommendations. United European Gastroenterol J. 2021 Feb 22;9(1):13–37.

Rex DK, Schoenfeld PS, Cohen J, Pike IM, Adler DG, Fennerty MB, et al. Quality indicators for colonoscopy. Gastrointest Endosc. 2015 Jan;81(1):31–53.

Dhar A, Haboubi HN, Attwood SE, Auth MKH, Dunn JM, Sweis R, et al. British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines on the diagnosis and management of eosinophilic oesophagitis in children and adults. Gut. 2022 Aug;71(8):1459–87.

Pouw RE, Barret M, Biermann K, Bisschops R, Czakó L, Gecse KB, et al. Endoscopic tissue sampling - Part 1: Upper gastrointestinal and hepatopancreatobiliary tracts. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2021 Nov;53(11):1174–88.

Al-Toma A, Volta U, Auricchio R, Castillejo G, Sanders DS, Cellier C, et al. European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United European Gastroenterol J. 2019 Jun;7(5):583–613.

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Moayyedi P, Deeks J, Talley NJ, Delaney B, Forman D. An update of the Cochrane systematic review of Helicobacter pylori eradication therapy in nonulcer dyspepsia: resolving the discrepancy between systematic reviews. Am J Gastroenterol. 2003 Dec;98(12):2621–6.

11.

Pouw RE, Bisschops R, Gecse KB, de Hertogh G, Iacucci M, Rutter M, et al. Endoscopic tissue sampling - Part 2: Lower gastrointestinal tract. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2021 Dec;53(12):1261–73.

12.

Pimentel-Nunes P, Libânio D, Marcos-Pinto R, Areia M, Leja M, Esposito G, et al. Management of epithelial precancerous conditions and lesions in the stomach (MAPS II): European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter and Microbiota Study Group (EHMSG), European Society of Pathology (ESP), and Sociedade Portuguesa de Endoscopia Digestiva (SPED) guideline update 2019. Endoscopy. 2019 Apr;51(4):365–88.

13.

Weusten BLAM, Bisschops R, Dinis-Ribeiro M, di Pietro M, Pech O, Spaander MCW, et al. Diagnosis and management of Barrett esophagus: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2023 Dec;55(12):1124–46.

14.

Shaheen NJ, Falk GW, Iyer PG, Souza RF, Yadlapati RH, Sauer BG, et al. Diagnosis and Management of Barrett’s Esophagus: An Updated ACG Guideline. Am J Gastroenterol. 2022 Apr 1;117(4):559–87.

15.

Jung KW, Talley NJ, Romero Y, Katzka DA, Schleck CD, Zinsmeister AR, et al. Epidemiology and natural history of intestinal metaplasia of the gastroesophageal junction and Barrett’s esophagus: a population-based study. Am J Gastroenterol. 2011 Aug;106(8):1447–55; quiz 1456.

16.

Sancho-Poch FJ, Balanzó J, Ocaña J, Presa E, Sala-Cladera E, Cussó X, et al. An evaluation of gastric biopsy in the diagnosis of gastric cancer. Gastrointest Endosc. 1978 Nov;24(6):281–2.

17.

Misumi A, Mori K, Ikeda T, Misumi K, Ookubo F, Shimamoto M, et al. Evaluation of fibergastroscopic biopsy in the diagnosis of gastric cancer: a study of 339 cases. Gastroenterol Jpn. 1978;13(4):255–63.

18.

Lal N, Bhasin DK, Malik AK, Gupta NM, Singh K, Mehta SK. Optimal number of biopsy specimens in the diagnosis of carcinoma of the oesophagus. Gut. 1992 Jun;33(6):724–6.

19.

Choi Y, Choi HS, Jeon WK, Kim BI, Park D Il, Cho YK, et al. Optimal number of endoscopic biopsies in diagnosis of advanced gastric and colorectal cancer. J Korean Med Sci. 2012 Jan;27(1):36–9.

20.

Kwack WG, Ho WJ, Kim JH, Lee JH, Kim EJ, Kang HW, et al. Understanding the diagnostic yield of current endoscopic biopsy for gastric neoplasm: A prospective single-center analysis based on tumor characteristics stratified by biopsy number and site. Medicine. 2016 Jul;95(30):e4196.

21.

Pimenta-Melo AR, Monteiro-Soares M, Libânio D, Dinis-Ribeiro M. Missing rate for gastric cancer during upper gastrointestinal endoscopy: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2016 Sep;28(9):1041–9.

22.

Han KS, Sohn DK, Choi DH, Hong CW, Chang HJ, Lim SB, et al. Prolongation of the period between biopsy and EMR can influence the nonlifting sign in endoscopically resectable colorectal cancers. Gastrointest Endosc. 2008 Jan;67(1):97–102.

23.

Polkowski M, Jenssen C, Kaye P, Carrara S, Deprez P, Gines A, et al. Technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline - March 2017. Endoscopy. 2017 Oct;49(10):989–1006.

24.

de Moura DTH, McCarty TR, Jirapinyo P, Ribeiro IB, Flumignan VK, Najdawai F, et al. EUS-guided fine-needle biopsy sampling versus FNA in the diagnosis of subepithelial lesions: a large multicenter study. Gastrointest Endosc. 2020 Jul;92(1):108-119.e3.

25.

Gkolfakis P, Crinò SF, Tziatzios G, Ramai D, Papaefthymiou A, Papanikolaou IS, et al. Comparative diagnostic performance of end-cutting fine-needle biopsy needles for EUS tissue sampling of solid pancreatic masses: a network meta-analysis. Gastrointest Endosc. 2022 Jun;95(6):1067-1077.e15.

26.

Mohan BP, Madhu D, Reddy N, Chara BS, Khan SR, Garg G, et al. Diagnostic accuracy of EUS-guided fine-needle biopsy sampling by macroscopic on-site evaluation: a systematic review and meta-analysis. Gastrointest Endosc. 2022 Dec;96(6):909-917.e11.

27.

Zaidman JS, Frederick WG, Furth EE, Su CG, Ginsberg GG. Comparison of Pelican single-use multibite biopsy forceps and traditional double-bite forceps: evaluation in a porcine model. Gastrointest Endosc. 2006 Oct;64(4):582–8.

28.

Technology Assessment Committe, Barkun A, Liu J, Carpenter S, Chotiprasidhi P, Chuttani R, et al. Update on endoscopic tissue sampling devices. Gastrointest Endosc. 2006 May;63(6):741–5.

Abstract

Tissue sampling during endoscopic procedures is a fundamental aspect of investigating digestive diseases, with histological examination playing a crucial role in almost every case. Given its prevalence, the potential for mistakes is significant. Therefore, understanding the appropriate indications, techniques, and consequences of tissue sampling is essential for gastroenterologists. Key questions to consider before taking a biopsy or acquiring tissue include: Why? What for? How? How many?

This manuscript addresses these critical questions by detailing the eight most frequent and correctable mistakes in tissue acquisition during endoscopy. The recommendations provided are largely supported by existing guidelines and evidence, with some insights drawn from the authors' professional experience.

Topics

Digestive Oncology Endoscopy

Citation

Pita I, Bastos P and Dinis-Ribeiro M. Mistakes in tissue acquisition during endoscopy and how to avoid them. UEG Education 2017; 17: 45–47.

Published

2024

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The European Multidisciplinary Evidence-Based Guideline on Pancreatic Cancer: Methodological Protocol

Laura Leeuwenburgh

Summary

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Summary is not available for this content yet.

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Guideline

ABSTRACT

Background

Pancreatic cancer remains one of the most lethal cancers despite extensive efforts and research conducted over the past decades. To effectuate groundbreaking improvements in pancreatic cancer treatment, interdisciplinary and international collaboration is essential. Evidence-based guidelines, including state-of-the-art evidence and expert opinion, are crucial to guide medical specialists, researchers, and patients, especially on issues where consensus is still lacking. This article describes the methodological protocol for the development of the European Multidisciplinary Evidence-Based Guideline on Pancreatic Cancer. The guideline aims to identify current knowledge gaps on pancreatic cancer management, develop questions based on these knowledge gaps, and answer these questions with evidence-based recommendations supplemented, when evidence is lacking, with expert advice for treatment and future research.

Methods

This guideline development protocol is developed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The process is structured into six stages: First, 13 theme-based multidisciplinary working groups are established, comprising representatives from 30 European medical and patient societies. Second, these working groups identify the most relevant current knowledge gaps on pancreatic cancer within their theme and formulate key questions. Third, the available evidence to answer these key questions is obtained through systematic reviews and the certainty of evidence is assessed using the GRADE approach. Fourth, recommendations are developed based on the available evidence. Fifth, all participants reach consensus on the recommendations through a modified Delphi process. Sixth, the recommendations are discussed during an open conference, including an external validation committee.

Discussion

This methodological protocol of the European Multidisciplinary Evidence-Based Guideline on Pancreatic Cancer is designed to identify key knowledge gaps across 13 themes and formulate evidence-based recommendations. This guideline initiative unites 30 European medical and patient societies for pancreatic cancer.

Summary

Methodological protocol of an international multi-disciplinary guideline involving 30 European medical and patient societies.
This protocol highlights the six stages of the guideline development process, adhering to the key principles of the GRADE methodology, and thereby aims to maximise transparency and methodological quality.
With addressing knowledge gaps, this guideline will uncover areas with limited evidence. A priority rating for research needs, based on a survey, will be established, highlighting areas where future research is most warranted.

Guideline

Clinical Practice Guideline

Topics

Pancreas

Citation

Clinical and Public Health Guidelines 3 (2026)

Published

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Published

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Mistakes in acute abdominal CT and how to avoid them

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8

Rex DK, Schoenfeld PS, Cohen J, Pike IM, Adler DG, Fennerty MB, et al. Quality indicators for colonoscopy. Gastrointest Endosc. 2015 Jan;81(1):31–53.

10.

11.

12.

13.

14.

Shaheen NJ, Falk GW, Iyer PG, Souza RF, Yadlapati RH, Sauer BG, et al. Diagnosis and Management of Barrett’s Esophagus: An Updated ACG Guideline. Am J Gastroenterol. 2022 Apr 1;117(4):559–87.

15.

16.

Sancho-Poch FJ, Balanzó J, Ocaña J, Presa E, Sala-Cladera E, Cussó X, et al. An evaluation of gastric biopsy in the diagnosis of gastric cancer. Gastrointest Endosc. 1978 Nov;24(6):281–2.

17.

18.

Lal N, Bhasin DK, Malik AK, Gupta NM, Singh K, Mehta SK. Optimal number of biopsy specimens in the diagnosis of carcinoma of the oesophagus. Gut. 1992 Jun;33(6):724–6.

19.

Choi Y, Choi HS, Jeon WK, Kim BI, Park D Il, Cho YK, et al. Optimal number of endoscopic biopsies in diagnosis of advanced gastric and colorectal cancer. J Korean Med Sci. 2012 Jan;27(1):36–9.

20.

21.

22.

23.

24.

25.

26.

27.

28.

Technology Assessment Committe, Barkun A, Liu J, Carpenter S, Chotiprasidhi P, Chuttani R, et al. Update on endoscopic tissue sampling devices. Gastrointest Endosc. 2006 May;63(6):741–5.

Abstract

Abdominal CT (computed tomography) is among the most common imaging tests performed for the investigation of acute abdominal pathology. There are many pitfalls that clinicians and radiologists should be aware of when requesting these studies and interpreting the findings. This article covers ten mistakes frequently made with abdominal CT, focusing on gastrointestinal tract and hepatobiliary pathology. These mistakes and their discussions are based on the available literature where possible and thereafter on our clinical experience.

Topics

Radiology & Imaging

Citation

Rafiee H and Taylor S. Mistakes in acute abdominal CT and how to avoid them. UEG Education 2017; 17: 18–23.

Published

2024

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Mistakes in cases on call and how to avoid them

Xavier Dray, Marine Camus

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8

Rex DK, Schoenfeld PS, Cohen J, Pike IM, Adler DG, Fennerty MB, et al. Quality indicators for colonoscopy. Gastrointest Endosc. 2015 Jan;81(1):31–53.

10.

11.

12.

13.

14.

Shaheen NJ, Falk GW, Iyer PG, Souza RF, Yadlapati RH, Sauer BG, et al. Diagnosis and Management of Barrett’s Esophagus: An Updated ACG Guideline. Am J Gastroenterol. 2022 Apr 1;117(4):559–87.

15.

16.

Sancho-Poch FJ, Balanzó J, Ocaña J, Presa E, Sala-Cladera E, Cussó X, et al. An evaluation of gastric biopsy in the diagnosis of gastric cancer. Gastrointest Endosc. 1978 Nov;24(6):281–2.

17.

18.

Lal N, Bhasin DK, Malik AK, Gupta NM, Singh K, Mehta SK. Optimal number of biopsy specimens in the diagnosis of carcinoma of the oesophagus. Gut. 1992 Jun;33(6):724–6.

19.

Choi Y, Choi HS, Jeon WK, Kim BI, Park D Il, Cho YK, et al. Optimal number of endoscopic biopsies in diagnosis of advanced gastric and colorectal cancer. J Korean Med Sci. 2012 Jan;27(1):36–9.

20.

21.

22.

23.

24.

25.

26.

27.

28.

Technology Assessment Committe, Barkun A, Liu J, Carpenter S, Chotiprasidhi P, Chuttani R, et al. Update on endoscopic tissue sampling devices. Gastrointest Endosc. 2006 May;63(6):741–5.

Abstract

It is a difficult task and a great responsibility to evaluate and manage patients with acute - and potentially life-threatening - clinical presentations. It is even more complex to achieve high standards of care for cases on call. Indeed, on-call gastroenterologists, hepatologists and endoscopists are faced with a wide and protean range of gastrointestinal, liver and pancreatic emergencies. The decision-making process for cases on call is mainly based on information received over the phone, on medical knowledge and clinical experience, and on the resources available. As the degree of confidence in any information given on call may vary, it is of tremendous importance to note, and to document, with precise timing, what has been communicated by, proposed to, and eventually decided with, multiple caregivers (i.e. nurses, emergency physicians, intensive care physicians, surgeons, radiologists etc.)

Topics

Endoscopy Surgery

Citation

Dray X and Marteau P. Mistakes in cases on call and how to avoid them. UEG Education 2017; 17: 30–32

Published

2024

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Abstract

Topics

Endoscopy Hepatobiliary IBD Pancreas

Published

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