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:
Corresponding author: Barbara Braden, FEBG, FRCP, Professor, Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford OX3 9DU, United Kingdom.
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
Research background

Subepithelial tumours of the gastrointestinal tract can be benign, pre-malignant or malignant. Most small tumours are benign. Lipoma, leiomyoma, pancreatic rests or duplications cyst will usually not need further follow-up. Gastrointestinal stromal tumours or neuroendocrine tumours will require resection or surveillance. Metastasis to the gastrointestinal wall can rarely also present as subepithelial lesion.

Research motivation

Histology acquisition from subepithelial tumours is challenging as conventional endoscopic biopsies do usually not reach deeper than the mucosal layer. Subepithelial tumours often present a diagnostic dilemma.

Research objectives

The authors investigated the use, the safety and the diagnostic success of performing tunnel biopsies from subepithelial tumours to obtain histology.

Research methods

Tunnel biopsy was defined as repeating at least 10 double pass biopsies targeting the identical spot on the subepithelial mass with conventional biopsy forceps. All patients with subepithelial tumours reported at oesophagogastroduodenoscopy presenting within the 6 year study period were included and data were analysed regarding size and location of the tumour, histology, radiological findings, re-admissions and adverse events.

Research results

Only in about half of the 229 encountered subepithelial tumours tunnel biopsies were attempted. However, when tunnel biopsies were performed, they were diagnostic in 53.6%. Adverse events were not observed.

Research conclusions

Performing tunnel biopsies from subepithelial tumours during endoscopy prolongs the procedure only a few minutes but can save endoscopic ultrasound-guided sampling or the need for follow-up in about 50%.

Research perspectives

Further randomized studies with cost-analysis should assess the diagnostic yield of tunnel biopsies performed at the index endoscopy compared with endoscopic ultrasound-guided sampling.