EFFECT OF FORCEPS SIZE AND MODE OF ORIENTATION ON ENDOSCOPIC SMALL-BOWEL BIOPSY EVALUATION

Endoscopy is increasingly being used to obtain duodenal biopsy specime ns in suspected small intestinal malabsorption. We have prospectively evaluated the effect of standard and jumbo biopsy forceps, as well as the mode of orientation of the specimens (naked eye or stereomicroscop y), on duodenal biopsy weight, length, depth, and orientation in 18 co nsecutive patients. A pair of biopsy specimens was obtained from each patient by each type of forceps in random order. After they had been w eighed, one biopsy specimen from each pair was oriented stereomicrosco pically and all four were blindly evaluated by two pathologists. The b iopsy specimens obtained with the jumbo forceps were significantly lar ger (15.9 +/- 6.9 mg, mean +/- SD) and longer (0.6 + 0.2 cm) than thos e obtained with the standard forceps (8.0 +/- 1.3 mg, 0.4 +/- 0.2 cm, respectively; p < 0.001). Seventy-two percent of the jumbo biopsy spec imens that were oriented with stereomicroscopy included a minimum of f our villi in a row, as compared to 44% of the eye-oriented jumbo speci mens and less than 39% of the standard specimens, irrespective of the mode of orientation (p = 0.02). These results indicate that the jumbo forceps is superior to the standard, because it produces a larger duod enal mucosal specimen, usually suitable for optimal histologic evaluat ion when oriented with stereomicroscopy.