Can the 1.8 mm transnasal biopsy forceps instead of standard 2.2 mm alter rapid urease test and histological diagnosis?

Jeon, Su Jin; Shin, Sung Jae; Lee, Kee Myung; Lim, Sun Kyu; Lee, Yoon Chul; Lee, Myung Hee; Hwang, Jae Cheol; Cheong, Jae Youn; Yoo, Byung Moo; Kim, Jin Hong

doi:10.1111/j.1440-1746.2012.07152.x

Cited by 5 publications

(4 citation statements)

References 19 publications

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“…Some models, particularly those with the smallest shafts, have two-way (up and down) rather than conventional four-way tip deflection, but with the developments in CCD technology the latest models have not only conventional four-way tip deflection, but also a field of view of 120–140° and image enhancement (flexible spectral imaging colour enhancement (FICE)) capabilities. Due to a smaller working channel, the sizes of biopsy samples obtained with smaller diameter biopsy forceps are smaller (1.8 mm compared with 2.2 mm) but they are of comparable thickness; the smaller size has not been found to significantly affect their diagnostic performance 16 17. The new generation of TNE scopes now available offers a 2.4 mm channel allowing the passage of standard biopsy forceps.…”

Section: Technical Characteristicsmentioning

confidence: 99%

Transnasal endoscopy: no gagging no panic!

Parker

Alexandridis

Plevris

et al. 2015

Frontline Gastroenterol

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Background Transnasal endoscopy (TNE) is performed with an ultrathin scope via the nasal passages and is increasingly used. This review covers the technical characteristics, tolerability, safety and acceptability of TNE and also diagnostic accuracy, use as a screening tool and therapeutic applications. It includes practical advice from an ear, nose, throat (ENT) specialist to optimise TNE practice, identify ENT pathology and manage complications. Methods A Medline search was performed using the terms "transnasal", "ultrathin", "small calibre", "endoscopy", "EGD" to identify relevant literature. Results There is increasing evidence that TNE is better tolerated than standard endoscopy as measured using visual analogue scales, and the main area of discomfort is nasal during insertion of the TN endoscope, which seems remediable with adequate topical anaesthesia. The diagnostic yield has been found to be similar for detection of Barrett's oesophagus, gastric cancer and GORDassociated diseases. There are some potential issues regarding the accuracy of TNE in detecting small early gastric malignant lesions, especially those in the proximal stomach. TNE is feasible and safe in a primary care population and is ideal for screening for upper gastrointestinal pathology. It has an advantage as a diagnostic tool in the elderly and those with multiple comorbidities due to fewer adverse effects on the cardiovascular system. It has significant advantages for therapeutic procedures, especially negotiating upper oesophageal strictures and insertion of nasoenteric feeding tubes.Conclusions TNE is well tolerated and a valuable diagnostic tool. Further evidence is required to establish its accuracy for the diagnosis of early and small gastric malignancies. There is an emerging role for TNE in therapeutic endoscopy, which needs further study.

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Section: Technical Characteristicsmentioning

confidence: 99%

Transnasal endoscopy: no gagging no panic!

Parker

Alexandridis

Plevris

et al. 2015

Frontline Gastroenterol

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“…TNE also permits comparable histological sampling. Despite its 2.4 mm working channel, the finding that all biopsies were of sufficient diagnostic quality mirrors data elsewhere on the high performance of TNE biopsies 18 19. Their performance here in all cases of EoE and short-segment Barrett’s oesophagus lends support to an expanded role of TNE in the surveillance and follow-up of these conditions, although further work comparing dysplasia detection rates in Barrett’s oesophagus between TNE and c-OGD would be welcomed.…”

Section: Discussionmentioning

confidence: 60%

Transnasal endoscopy: moving from endoscopy to the clinical outpatient–blue sky thinking in oesophageal testing

Lim

Haboubi

Anderson

et al. 2022

Frontline Gastroenterol

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BackgroundCOVID-19 has severely affected UK endoscopy services with an estimate 86% loss of activity during the first wave. Subsequent delays in diagnostic and surveillance procedures highlight the need for novel solutions to tackle the resultant backlog. Transnasal endoscopy (TNE) provides an attractive option compared with conventional upper gastrointestinal endoscopy given its limited use of space, no sedation and reduced nursing resources.Our experienceWe describe piloting and then establishing an outpatient model TNE service in the pandemic era and the implications on resource allocation, training and workforce. We also discuss our experiences and outline ways in which services can evolve to undertake more complex endoscopic diagnostic and therapeutic work. Over 90% of patients describe no discomfort and those who have previously experienced conventional transoral endoscopy preferred the transnasal approach. We describe a low complication rate (0.8%) comprising two episodes of mild epistaxis. The average procedure duration was reasonable (9.9±5.0 min) with full adherence to Joint Advisory Group quality standards. All biopsies assessed were deemed sufficient for diagnosis including those for surveillance procedures.DiscussionTNE can offer a safe, tolerable, high-quality service outside of a conventional endoscopy setting. Expanding procedural capacity without impacting on the current endoscopy footprint has great potential in recovering endoscopy services following the COVID-19 pandemic. Looking forward, TNE has potential to be used both within the endoscopy suite as part of therapeutic procedures, or outside of the endoscopy unit in outpatient clinics, community hospitals, or mobile units and to achieve this in a more sustainable and environmentally friendly way.

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“…To enable the precise maneuvers needed to closely visualize the pharynx and larynx, Transnasal Panendoscopy is performed with an ultrathin esophagoscope whose working length is around 60 cm (e.g., Model EE1580K; Pentax Corporation, Tokyo, Japan), and not with an ultrathin gastroscope. Biopsies are obtained using 1.8 mm biopsy forceps which have been shown to have similar histological diagnostic yields below the upper esophageal sphincter 19 . The standard operating procedure for obtaining endoscopic views during Transnasal Panendoscopy has been previously described 20 …”

Section: Methodsmentioning

confidence: 99%

“…Biopsies are obtained using 1.8 mm biopsy forceps which have been shown to have similar histological diagnostic yields below the upper esophageal sphincter. 19 The standard operating procedure for obtaining endoscopic views during Transnasal Panendoscopy has been previously described. 20 Referral and clinical information were retrospectively obtained from patient records.…”

Section: Key Pointsmentioning

confidence: 99%

A multidisciplinary approach to identifying and managing heterotopic gastric inlet patches

Ayres,

Perring,

Nouraei

2024

Neurogastroenterology Motil

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IntroductionGastric inlet patches are often incidental, but can also be a treatable cause of laryngo‐esophageal symptoms.MethodsWe retrospectively reviewed all patients whose gastric inlet patches were diagnosed following assessment for laryngopharyngeal and swallowing symptoms. Improvement following Argon Plasma Coagulation (APC) was assessed using Minimum Clinically‐Important Difference methodology combining voice, throat, and swallowing domains. Correlations between APC response and measures of reflux and mucosal barrier integrity, measured during 24‐h pH‐impedance manometry, were obtained. Proximal and Distal Mean Nocturnal Baseline Impedance (MNBI) values were separately calculated and the novel variable of Mucosal Impedance Gradient was derived as [((Distal MNBI‐Proximal MNBI)/((Distal MNBI + Proximal MMBI)/2)) x 100].Key ResultsInlet patches were detected in 57 of 651 patients who had Transnasal Panendoscopy (8.7 ± 2.2%). There were 34 males. Mean age was 58 years. Mean duration of symptoms was 2 years. The commonest symptoms were hoarseness (n = 33), throat symptoms (n = 24), and dysphagia (n = 21), respectively. APC was used to ablate patches in 34 patients. Treatment response was 71% at a mean followup of 5.5 months. MIG > − 25% predicted response to APC, with area under the receiver operating characteristic curve of 0.875 (Sensitivity = 81%; Specificity = 100%; p < 0.0001).ConclusionsGastric inlet patches are common and under‐recognized. They can cause protracted pharyngo‐esophageal symptoms. Patch ablation is an effective treatment for carefully selected patients. Optimal patient selection requires multidisciplinary teamwork. Mucosal Impedance Gradient could further refine patient selection.

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Can the 1.8 mm transnasal biopsy forceps instead of standard 2.2 mm alter rapid urease test and histological diagnosis?

Abstract: At least two samples using 1.8 mm forceps might be needed to obtain similar results on the CLO test using 2.2 mm. But, the size difference between two forceps did not influence the histological diagnosis.

Cited by 5 publications

References 19 publications

Transnasal endoscopy: no gagging no panic!

Transnasal endoscopy: no gagging no panic!

Transnasal endoscopy: moving from endoscopy to the clinical outpatient–blue sky thinking in oesophageal testing

A multidisciplinary approach to identifying and managing heterotopic gastric inlet patches

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