Randomized comparison of 3 different-sized biopsy forceps for quality of sampling in Barrett's esophagus

Abstract

Background: Several types of forceps are available for use in sampling Barrett's esophagus (BE). Few data exist with regard to biopsy quality for histologic assessment.

Objective: To evaluate sampling quality of 3 different forceps in patients with BE.

Design: Single-center, randomized clinical trial.

Patients: Consecutive patients with BE undergoing upper endoscopy.

Interventions: Patients randomized to have biopsy specimens taken with 1 of 3 types of forceps: standard, large capacity, or jumbo.

Main outcome measurements: Specimen adequacy was defined a priori as a well-oriented biopsy sample 2 mm or greater in diameter and with at least muscularis mucosa present.

Results: A total of 65 patients were enrolled and analyzed (standard forceps, n = 21; large-capacity forceps, n = 21; jumbo forceps, n = 23). Compared with jumbo forceps, a significantly higher proportion of biopsy samples with large-capacity forceps were adequate (37.8% vs 25.2%, P = .002). Of the standard forceps biopsy samples, 31.9% were adequate, which was not significantly different from specimens taken with large-capacity (P = .20) or jumbo (P = .09) forceps. Biopsy specimens taken with jumbo forceps had the largest diameter (median, 3.0 mm vs 2.5 mm [standard] vs 2.8 mm [large capacity]; P = .0001). However, jumbo forceps had the lowest proportion of specimens that were well oriented (overall P = .001).

Limitations: Heterogeneous patient population precluded dysplasia detection analyses.

Conclusions: Our results challenge the requirement of jumbo forceps and therapeutic endoscopes to properly perform the Seattle protocol. We found that standard and large-capacity forceps used with standard upper endoscopes produced biopsy samples at least as adequate as those obtained with jumbo forceps and therapeutic endoscopes in patients with BE.

Figure 1

Photomicrograph of an adequate biopsy sample, defined as a diameter of 2 mm or greater, properly oriented, and containing at least muscularis mucosa (H&E, orig. mag. ×4).

Figure 2

Proportions of biopsy samples adequate for pathologic assessment in patients with BE compared among standard, large-capacity, and jumbo forceps.

Figure 3

Proportions of biopsy samples properly oriented in patients with BE compared among standard, large-capacity, and jumbo forceps.

Figure 4

Median diameter (with interquartile range) of biopsy samples from patients with BE compared among standard, large-capacity, and jumbo forceps. Biopsy specimens taken with jumbo forceps had a significantly larger diameter than those obtained with large-capacity (P = .003) and standard (P = .0001) forceps. There was no difference in the diameter of samples obtained with standard and large-capacity forceps (P = .19).