Small intestinal disease – is endoscopic biopsy the answer?

Abstract

Endoscopic biopsy of the canine and feline small intestine is becoming more widely available and is generally preferred to surgical biopsy. However, it has limitations which must be recognised if the appropriate interpretation of biopsy findings is to be made. Lack of histological changes in biopsy specimens is a frequent and often frustrating finding, until it is understood that it may reflect either the inevitable problem of examining only the proximal intestine or the fact that not all intestinal diseases are associated with morphological changes. Some newer advances in non‐biopsy methods for investigating small intestinal disease are described.

Interobserver variation among histopathologic evaluations of intestinal tissues from dogs and cats

“…Histologic evaluation of the digestive tract is acknowledged to be difficult. 25 Interobserver variation between pathologists has been described in human pathology 26 including gastrointestinal pathology, in which there are sometimes blatant differences in diagnostic criteria. 27,28 Taken in this light, the uniformity or near-uniformity of results in 7 of 14 slides in our study is encouraging.…”

Complications following full‐thickness small intestinal biopsy in 66 dogs: a retrospective study

“…Diagnostic tests include faecal analysis, blood analysis, radiography, ultrasonography, endoscopy and culture of duodenal fluid. Intestinal biopsy should always be used in conjunction with other techniques since the samples obtained are focal and may be unrepresentative of the true condition (Hall 1994). Biopsies should be used to investigate severe acute or chronic gastrointestinal disease when other diagnostic techniques have failed.…”

“…Biopsies should be used to investigate severe acute or chronic gastrointestinal disease when other diagnostic techniques have failed. Normal biopsy results may indicate causes of malabsorption outside the intestine (Hall 1994) but may also represent false negative results (Loth and others 1990).…”

“…However, it does offer a number of advantages over minimally invasive techniques. It does not require specialist endoscopic expertise or equipment, it provides larger full-thickness samples, and allows the whole GIT and other abdominal viscera to be accessed, inspected and biopsied (Hall 1994).…”

The incidence of surgical site dehiscence following full‐thickness gastrointestinal biopsy in dogs and cats and associated risk factors

“…It is therefore often necessary to obtain a tissue sample for histopathological analysis in order to reach a definitive diagnosis and subsequently provide an appropriate treatment plan and prognosis. Gastrointestinal biopsies can either be obtained endoscopically or surgically, and there are specific advantages and limitations associated with each of these techniques (Hall ). Whilst obtaining an endoscopic gastrointestinal biopsy is a minimally invasive procedure with rapid recovery times, there are limitations to the size, depth and location of the biopsy sample that can be obtained via this method; tissue quality can vary, and patient preparation is required (Hall , Willard et al .…”