Brush cytology: An adjunct to diagnostic upper GI endoscopy

Abstract

Endoscopic brush cytology (EBC) was performed in antral and duodenal brushings of children subjected to upper GI endoscopy for the detection of H. pylori (Hp) and trophozoites of Giardia lamblia (Glt) in addition to routine endoscopic grasp biopsy (EGB). It was hospital based prospective study. EBC was performed in children subjected to upper GI endoscopy with a sheathed cytology brush. Mucosal brushings were collected from antrum, body of the stomach and second or third part of duodenum by gently rubbing the surface of the brush with the mucosal wall in all the directions, brush withdrawn and brushings performed on a glass slide. The smears were placed in 95% ethyl alcohol and later examined for Glt and Hp using Giemsa and Hematoxylin & Eosin stain. EGB was taken from antrum, body of the stomach and duodenum from sites other than those used for brushings. One hundred and seventy children between 1-13 years (median age = 5 years) were subjected to upper GI endoscopy for malabsorption (n = 94), recurrent abdominal pain (n = 49), failure to thrive (n = 16) and recurrent vomiting/regurgitation (n = 11) and EBC was performed in addition to routine EGB. Thirty five children (20.4%) were colonized by Hp, 14 (8.2%) were detected to have Glt and in 6 cases (3.5%) both Hp as well as Glt were detected. Out of 41 cases colonized by Hp, 24 cases (58.5%) were detected by EGB and 27 cases (65.8%) were detected by EBC. Out of 20 children in whom Glt were detected from their duodenum, the detection was by EBG in 12 cases (60%) and by EBC in as many as 19 cases (95%). Comparison of EGB and EBC suggested that detection rates with EBC were higher than EGB. Detection by EBC was significantly higher for Glt than Hp. There were no complications attributed to EBC and procedure time for endoscopy was not significantly prolonged. On the contrary, detection of Hp and particularly Glt in higher proportion of cases with the help of EBC was helpful in their appropriate management. Our results suggest that EBC is a safe and useful tool to enhance the value of diagnostic endoscopic procedure when used in combination with routine EGB.

Greater Than 95% Success with 14‐day Bismuth Quadruple Anti‐Helicobacter pylori Therapy: A Pilot Study in US Hispanics

“…Furthermore, although we did not design the study to validate Gram staining of smears versus culture results, we identified microscopically H. pylori forms in most specimens of infected individuals, thus providing another independent assessment of H. pylori status. Several studies comparing endoscopically obtained specimens for culture and microscopy have found agreement between culture and cytology . Clearly, orogastric bush staining provides a nonendoscopic alternative to current practices and potentially extends the ability to collect culture samples from sites where endoscopy is unavailable.…”

Cytopreparation of duodenal biopsy fixative improves detection rate of giardia in clinically suspected cases

“…Some studies suggest that the cytopathological techniques have better diagnostic yield. Work by Bendig et al and Patwari et al advocates the use of cytological methods such as duodenal brush cytology over stool examination. Panarelli et al applied morphometric technique and found that giardia trophozoites are more numerous and better visualised in cytology preparations as compared to tissue section with a significant P ‐value (< .05).…”

Significance of histologic grading using visual analogue scale in chronic gastritis

“…With regard to other Histological Features (Nongraded Variables) Eidt S developed a perspective which identifies surface epithelial damage, mucous depletion, and erosions. Our study was compared with study [14], These may be striking features in some cases of active H. pylori chronic gastritis. They have also mentioned that lymphoid aggregates with germinal centers are characteristic of chronic H. pylori gastritis and a hallmark of this diagnosis.…”

“…They have also mentioned that lymphoid aggregates with germinal centers are characteristic of chronic H. pylori gastritis and a hallmark of this diagnosis. The comparative analysis of different graded variables between Ahluwalia et al [14]. Afzal et al [15] Table 2.…”

“…They have also mentioned that lymphoid aggregates with germinal centers are characteristic of chronic H. pylori gastritis his diagnosis. The comparative analysis of different graded variables between Ahluwalia et al [14]. Afzal et al [15] et al [16] given in In a study by Pruthi, S [17] [19] where Lymphoid aggregates were significantly more frequent in H. pylori positive cases (87.5%).…”