Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2021; 9(21): 5822-5829
Published online Jul 26, 2021. doi: 10.12998/wjcc.v9.i21.5822
Tunneled biopsy is an underutilised, simple, safe and efficient method for tissue acquisition from subepithelial tumours
Andreas Koutsoumpas, Ruwan Perera, Adele Melton, Jonathan Kuker, Tilak Ghosh, Barbara Braden
Andreas Koutsoumpas, Ruwan Perera, Adele Melton, Barbara Braden, Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, United Kingdom
Jonathan Kuker, Senior School, Magdalen College School, Oxford OX4 0DZ, United Kingdom
Tilak Ghosh, Translational Gastroenterology Unit, Oxford University Hospital NHS Foundation Trust, Oxford OX3 9DU, United Kingdom
Author contributions: All authors contributed in data acquisition, analysis and interpretation of the data, critically revised, edited and approved the final version; Braden B drafted the study concept and first manuscript version; Koutsoumpas A and Perera R contributed equally and are shared first authors.
Institutional review board statement: The observational retrospective nature of the study was established with the Health Research Authority and Trust RD department. According to the Health Research Authority, this type of study does not require approval from a research ethics committee.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available to share.
STROBE statement: The authors have read the STROBE statement-checklist of items, and the manuscript was prepared and revised accordingly.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Barbara Braden, FEBG, FRCP, Professor, Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford OX3 9DU, United Kingdom. braden@em.uni-frankfurt.de
Received: March 21, 2021
Peer-review started: March 21, 2021
First decision: April 29, 2021
Revised: May 10, 2021
Accepted: May 26, 2021
Article in press: May 26, 2021
Published online: July 26, 2021
Processing time: 121 Days and 14.1 Hours
Abstract
BACKGROUND

Tissue acquisition from subepithelial lesions is often attempted by endoscopic ultrasound (EUS)-sampling as conventional endoscopic biopsy usually fails to reach deeper layers of the gastrointestinal wall.

AIM

To investigate the utilisation, safety and diagnostic yield of an intensified “bite-on-bite” tunnel biopsy technique.

METHODS

In this retrospective cohort study, all patients presenting with subepithelial masses in the upper gastrointestinal tract from March 2013 to July 2019 were included. Data were analysed for size and location of the subepithelial mass, use of intensified tunnel biopsy protocol (more than 10 double bite-on-bite biopsies) or superficial conventional biopsies, histology and imaging results, occurrence of readmission and adverse events after endoscopy.

RESULTS

Two hundred and twenty-nine patients with subepithelial lesions were included. Superficial conventional biopsies were taken in 117 patients and were diagnostic only in one lipoma (0.9 %). Tunnel biopsies taken in 112/229 (48.9%) patients were significantly more likely to provide histological diagnosis (53.6%; P < 0.001). For lesions ≥ 10mm the diagnostic yield of tunnel biopsies further increased to 41/67 (61.2%). No immediate or delayed complications were reported. Only 8 of the 51 endoscopists (15.7%) regularly attempted tunnel biopsies.

CONCLUSION

Tunnel biopsy is a simple, safe and efficient but underutilised diagnostic modality for tissue acquisition in subepithelial masses. It should be routinely attempted at the initial endoscopy.

Keywords: Gastrointestinal stromal tumour; Fine needle biopsy; Lipoma; Immunohistology; Neuroendocrine tumours; Fine needle biopsy

Core Tip: Subepithelal lesions are found relatively often on cross sectional imaging or during endoscopy. Conventional endoscopic biopsies will not reveal the histological diagnosis in most cases. Endoscopic ultrasound (EUS) with fine needle aspiration or biopsy allows the diagnosis in 50%-90% but requires specialist skills and equipment and is expensive. Tunnel biopsies taken in simple bite-on-bite technique allow histological diagnosis in more than 50% of subepithelial lesions. If tunnel biopsies are taken at the index endoscopy, further follow-up endoscopies and EUS investigations can be avoided in many cases.