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

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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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Abstract

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Digestive Oncology Endoscopy Oesophagus

Published

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Abstract

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Endoscopy

Published

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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

Hepatitis C virus (HCV) infection remains an important global health concern. It is estimated that there are approximately 50 million people infected with HCV globally, with around 1 million new infections each year and about 242,000 deaths annually attributed to HCV-related complications. Most acute HCV infections (55–85%) become chronic due to the virus’s effective evasion strategies, with spontaneous clearance being rare once chronicity is established. This condition often progresses silently, with many individuals unaware of their infection until advanced liver damage has occurred. If left untreated, HCV can lead to severe complications, including liver cirrhosis and hepatocellular carcinoma (HCC). HCV transmission occurs mainly through percutaneous exposure to infected blood. HCV can also spread from mother to infant (vertical transmission) and, less frequently, via sexual contact.1,2 In recent years, the introduction of oral direct-acting antivirals (DAAs), with remarkable safety and effectiveness profiles, has led to a sustained virological response (SVR) in virtually all (>97%) HCV-infected patients, regardless of HCV genotype or disease stage. However, significant barriers remain, such as issues with diagnosis, access to treatment and awareness of the disease.

Here, we discuss some of the misconceptions in HCV management and provide a practical management approach grounded in evidence and clinical experience.

Topics

Hepatobiliary

Citation

Garcia A.C and Alexandrino G. Mistakes in hepatits C and how to avoid them. UEG Education 2025; 25: 14-17.

Published

2025

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UEG Mistakes In Articles

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Mistakes in acute abdominal CT and how to avoid them

Hameed Rafiee, Stuart Taylor

Summary

AI Generated

Summary is not available for this content yet.

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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

Summary

AI Generated

Summary is not available for this content yet.

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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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Mistakes in small bowel bleeding and how to avoid them

Andrea Telese

UEG Mistakes In Articles

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

Mistakes in small bowel bleeding and how to avoid them

Andrea Telese, Alberto Murino, Edward J Despott

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

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

Over the past 17 years, the disruptive impact of technologies including small bowel capsule endoscopy (SBCE), device-assisted enteroscopy (DAE) and dedicated cross-sectional imaging has transformed the investigation and management of small bowel pathology. Although a small bowel source only accounts for 5–10% of all cases of gastrointestinal bleeding,definitive management of small bowel bleeding even in the current era of advanced imaging, can still pose formidable challenges. In this brief article, we highlight frequent mistakes made in the investigation and management of small bowel bleeding and discuss strategies for their avoidance.

Topics

Small Intestine & Nutrition

Citation

Despott EJ, Telese A and Murino A. Mistakes in small bowel bleeding and how to avoid them. UEG Education 2018; 18: 27–29.

Published

2024

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Pradeep Mundre

UEG Online Courses x UEG Podcast: Impact of polyp detection in colonoscopy

Veronique Van der Voort

Mistakes in hepatitis C and how to avoid them

Gonçalo Alexandrino

Mistakes in acute abdominal CT and how to avoid them

Hameed Rafiee

Mistakes in cases on call and how to avoid them

Marine Camus

Mistakes in small bowel bleeding and how to avoid them

Andrea Telese