HISTOLOGIC EVALUATION OF ENDOSCOPIC VERSUS SUCTION BIOPSIES OF SMALL-INTESTINAL MUCOSAE IN CHILDREN WITH AND WITHOUT CELIAC-DISEASE

Background: Concern over the adequacy of histologic diagnosis of endos copic duodenal biopsies in children prompted this comparative study on the histologic quality of endoscopic versus capsule biopsies. We foun d this problem addressed in only six previous reports. Methods: Blind examinations of the histologic sections of 48 duodenal biopsies obtain ed by gastrointestinal endoscopy in children aged 2-18 years were comp ared to 52 biopsies obtained by the small bowel suction method (from c hildren aged 1-16 years). Results: Although 87.5% of endoscopic biopsi es and 94.2% of capsule biopsies were adequate for histologic diagnosi s, fragmentation or squashing was seen in 83.3% of endoscopic biopsies and only in 25% of capsule biopsies. Conclusions: Biopsies obtained b y suction are of better quality than those obtained by endoscopy. If e ndoscopy is preferred for technical reasons, the following conditions should be observed: the patients should be aged over 2 years, and a mi nimum of four biopsies should be obtained with forceps of a diameter g reater than 2 mm. Adequate histologic criteria for diagnosis should in clude at least one full-thickness mucosal specimen more than 3 mm in l ength, vertically oriented, and not fragmented. In children under age 2, duodenal or jejunal capsule biopsies are preferred, since the speci mens are usually larger and less fragmented. Endoscopy is technically more difficult in the very young patient. (C) 1998 Lippincott-Raven Pu blishers.