Gastrointestinal Endoscopy
Volume 71, Issue 4 , Pages 831-834, April 2010

A novel method of full-thickness gastric biopsy via a percutaneous, endoscopically assisted, transenteric approach

Presented in abstract form at the 2009 Neurogastroenterology and Motility Joint International Meeting, August 27-30, 2009, Chicago, Illinois (Neurogastroenterol Motil 2009;21(suppl 1):6).

  • Hughie Fraser, MD, FRCPC

      Affiliations

    • Centre for Digestive Motility, Division of Gastroenterology, Department of Medicine, University of Calgary, Alberta, Canada
    • ,
  • Emil Neshev, MD

      Affiliations

    • Centre for Digestive Motility, Division of Gastroenterology, Department of Medicine, University of Calgary, Alberta, Canada
    • ,
  • Martin Storr, MD

      Affiliations

    • Centre for Digestive Motility, Division of Gastroenterology, Department of Medicine, University of Calgary, Alberta, Canada
    • ,
  • Stefan J. Urbanski, MD

      Affiliations

    • Department of Anatomic Pathology, University of Calgary, Alberta, Canada
    • ,
  • Christopher N. Andrews, MD, MSc, FRCPC

      Affiliations

    • Centre for Digestive Motility, Division of Gastroenterology, Department of Medicine, University of Calgary, Alberta, Canada
    • Corresponding Author InformationReprint requests: Christopher N. Andrews, MD, MSc, FRCPC, Assistant Professor, Division of Gastroenterology, University of Calgary, TRW Building, Room 6D24, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4N1, Canada

Received 24 August 2009; accepted 24 November 2009.

Background

Pathologic changes of the enteric nervous system of the stomach have been described in gastroparesis. Because the enteric nervous system lies within the myenteric plexus between the muscle layers of the stomach, it is not accessible by standard biopsy forceps. Thus, tissue must be obtained by laparoscopy or laparotomy. Obtaining full-thickness biopsies with a less-invasive method would be an ideal alternative.

Objective

To assess the safety and feasibility of a novel method of gastric, full-thickness biopsy by using a percutaneous, endoscopically assisted, transenteric approach.

Design

Experimental pilot study in 3 dogs, approved by the animal care committee.

Intervention

Under general anesthesia, dogs underwent gastroscopy, and a suitable biopsy area was chosen, based on indentation of the anterior stomach wall by external finger pressure on the abdominal skin and by endoscope transillumination. Using sterile technique, we made a 3-mm incision through the abdominal skin, and a spring-loaded, 14-gauge biopsy needle was used to take 4 separate antral biopsies from each dog, with no mucosal or abdominal closure intervention.

Main Outcome Measurements

Feasibility of obtaining enteric nervous system tissue; morbidity and mortality at 4 weeks; gross pathology at necropsy.

Results

The procedure was well tolerated by the dogs, with no morbidity or mortality at any time, up to 4 weeks after the procedure. Adequate tissue specimens were obtained for histologic analysis of all layers of the stomach, including enteric nervous system elements.

Limitations

Biopsy size was smaller than a surgical biopsy size.

Conclusion

The percutaneous, endoscopically assisted, transenteric approach, full-thickness biopsy technique is safe and obtains enteric nervous tissue in a simple, minimally invasive manner.

Abbreviations: ENS, enteric nervous system, PEATE, percutaneous endoscopically assisted transenteric approach

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 DISCLOSURE:C.N. Andrews was funded in part by Calgary Laboratory Services research and development grant RE7133. All other authors disclosed no financial relationships relevant to this publication.

 If you want to chat with an author of this article, you may contact Dr Andrews at candrews@ucalgary.

PII: S0016-5107(09)02847-8

doi:10.1016/j.gie.2009.11.048

Gastrointestinal Endoscopy
Volume 71, Issue 4 , Pages 831-834, April 2010

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