Use of a new jumbo forceps improves tissue acquisition of Barrett's esophagus surveillance biopsies

Background

The major risk factors for the development of esophageal adenocarcinoma remain long-standing GERD and resultant Barrett's esophagus (BE). Finding the exact method of adequate tissue sampling for surveillance of dysplasia in BE remains a dilemma.

Objective

We prospectively compared standard large-capacity biopsy forceps with a new jumbo biopsy forceps for dysplasia detection in BE.

Setting/Design

Prospective, single-center investigation.

Patients/Interventions

We prospectively enrolled 32 patients undergoing surveillance endoscopy for BE. Biopsy samples were obtained in paired fashion alternating between the experimental (jumbo) and control (large-capacity) forceps.

Main Outcome Measurements

Each sample was assessed for histopathology, specimen size, and adequacy.

Results

A total of 712 specimens were available for analysis for this investigation. Six patients were found to have dysplasia, and in 5 of those patients, the dysplasia was only detected with the jumbo forceps. The mean width was significantly greater in the Radial Jaw 4 jumbo group (3.3 mm vs 1.9 mm [P < .005]) as was the mean depth (2.0 mm vs 1.1 mm [P < .005]). Sixteen percent of samples obtained with the standard forceps provided an adequate sample, whereas the jumbo forceps provided an adequate sample 79% of the time (P < .05).

Limitations

A lack of a validated index for assessment of tissue adequacy in BE.

Conclusion

The Radial Jaw 4 jumbo biopsy forceps significantly improves dysplasia detection and adequate tissue sampling in patients undergoing endoscopy for BE.

Abbreviations: BE, Barrett's esophagus, DGS, depth grade scale, HGD, high-grade dysplasia, IBD, inflammatory bowel disease, LGD, low-grade dysplasia, RJ3, Radial Jaw 3, RJ4, Radial Jaw 4