Endoscopy of the “brain”: the next frontier in gastroenterology

Grover, Madhusudan; Farrugia, Gianrico; Pasricha, Pankaj J.

doi:10.1016/j.gie.2015.10.011

Cited by 3 publications

(1 citation statement)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Percutaneous endoscopically assisted transenteric full-thickness biopsy using a 14-gauge needle for assessing histopathological abnormalities in GINMD showed abnormalities in 44% of patients 15 . Recently an EUS-guided fine-needle aspiration of the gastric antrum MP using a 19 gauge core-needle was shown to be safe with adequate tissue for histologic assessment of myenteric plexus in 54.5% and ICC in 81% of patients 16,17 . The limitations of these 2 techniques are the small sample volume of MP and the fragmented samples that can impair proper tissue orientation and impact diagnostic yield.…”

Section: Discussionmentioning

confidence: 99%

Innovative gastric endoscopic muscle biopsy to identify all cell types, including myenteric neurons and interstitial cells of Cajal in patients with idiopathic gastroparesis: a feasibility study (with video)

Rajan

Gostout

Song

et al. 2016

Gastrointestinal Endoscopy

Self Cite

View full text Add to dashboard Cite

Background and Aims The pathophysiology of some gastrointestinal neuromuscular diseases (GINMD) remains largely unknown. This is in part due to the inability to obtain ample deep gastric wall biopsies that include the intermuscular layer of the muscularis propria (MP) to evaluate the enteric nervous system, interstitial cells of Cajal (ICC) and related cells. We report on a novel technique for gastric endoscopic muscle biopsy (gEMB). Methods Patients with idiopathic gastroparesis were prospectively enrolled in a feasibility study using a novel “no hole” gEMB. Main outcome measures were technical success, adverse events and histological confirmation of the intermuscular layer, including myenteric neurons and ICC. The gEMB was a double resection clip–assist technique. A site was identified on the anterior wall of the gastric body as recommended by the International Working Group on histological techniques. Endoscopic mucosal resection was performed to unroof and expose the underlying MP. The exposed MP was then retracted into the cap of an over-the-scope clip. The clip was deployed and the pseudopolyp of MP created was resected. This resulted in a “nohole” gEMB. Results Three patients with idiopathic gastroparesis underwent gEMB. Patients had severe delayed gastric emptying with a mean of 49 ± 16.8% of retained gastric contents at 4 hours. They had no history of gastric or small-bowel surgery, and did not use steroids or other immunosuppressive drugs. The gEMB procedure was successfully performed with no procedural adverse events. Postprocedure abdominal pain was controlled with nonsteroidal anti-inflammatory agents and opioid analgesics. Mean length of resected MP was 10.3 ± 1.5 mm. Mean procedure time was 25.7 ± 6 minutes. Tissue samples on hematoxylin and eosin (H&E) stain confirmed presence of both inner circular and outer longitudinal muscle as well as the intermuscular layer. H&E stain showed reduced myenteric ganglia in 1 patient. In 2 patients, specialized immunohistochemistry was performed, which showed marked decrease in myenteric neurons as delineated by an antibody to Protein Gene Product (PGP) 9.5 and severe decrease in ICC across the muscle layers. At 1 month follow-up, upper endoscopy showed a well-healed scar in 2 patients and minimal ulceration with retained clip in 1 patient. CT abdomen confirmed the integrity of the gastric wall in all patients. Due to lack of an immune infiltrate in the resected samples, patients were not considered suitable for immunosuppressive or steroid therapy. Conclusions gEMB is feasible and easy to perform, with acquisition of tissue close to surgical samples to identify myenteric ganglia, ICC and multiple cell types. The ability to perform gEMB represents a paradigm shift in endoscopic tissue diagnosis of gastric neuromuscular pathologies.

show abstract

Section: Discussionmentioning

confidence: 99%