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Endoscopy 2021; 53(11): 1174-1188
DOI: 10.1055/a-1611-5091
Guideline

Endoscopic tissue sampling – Part 1: Upper gastrointestinal and hepatopancreatobiliary tracts. European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Roos E. Pouw
 1   Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Cancer Center Amsterdam, Amsterdam University Medical Centers location VUmc, Amsterdam, The Netherlands
,
Maximilien Barret
 2   Department of Gastroenterology and Digestive Oncology, Cochin Hospital and University of Paris, Paris, France
,
Katharina Biermann
 3   Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands
,
Raf Bisschops 
 4   Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
,
László Czakó
 5   First Department of Medicine, University of Szeged, Szeged, Hungary
,
Krisztina B. Gecse
 6   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers location AMC, Amsterdam, The Netherlands
,
Gert de Hertogh
 7   Department of Pathology, University Hospitals Leuven, Leuven, Belgium
,
Tomas Hucl
 8   Institute for Clinical and Experimental Medicine, Prague, Czech Republic
,
Marietta Iacucci
 9   Institute of Translational Medicine, Institute of Immunology and Immunotherapy and NIHR Birmingham Biomedical Research Centre, University Hospitals NHS Foundation Trust and University of Birmingham, Birmingham, UK
,
Marnix Jansen
10   Department of Histopathology, University College London Hospital, London, UK
,
Matthew Rutter 
11   Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK
,
Edoardo Savarino 
12   Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
,
Manon C. W. Spaander 
13   Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
,
Peter T. Schmidt
14   Department of Medicine (Solna), Karolinska Institute and Department of Medicine, Ersta Hospital, Stockholm, Sweden
,
Michael Vieth
15   Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg, Klinikum Bayreuth, Bayreuth, Germany
,
Mário Dinis-Ribeiro
16   Department of Gastroenterology, Portuguese Oncology Institute of Porto, Porto, Portugal
,
Jeanin E. van Hooft 
17   Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
› Author Affiliations
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Main Recommendations

1 ESGE recommends that, where there is a suspicion of eosinophilic esophagitis, at least six biopsies should be taken, two to four biopsies from the distal esophagus and two to four biopsies from the proximal esophagus, targeting areas with endoscopic mucosal abnormalities. Distal and proximal biopsies should be placed in separate containers.

Strong recommendation, low quality of evidence.

2 ESGE recommends obtaining six biopsies, including from the base and edge of the esophageal ulcers, for histologic analysis in patients with suspected viral esophagitis.

Strong recommendation, low quality of evidence.

3 ESGE recommends at least six biopsies are taken in cases of suspected advanced esophageal cancer and suspected advanced gastric cancer.

Strong recommendation, moderate quality of evidence.

4 ESGE recommends taking only one to two targeted biopsies for lesions in the esophagus or stomach that are potentially amenable to endoscopic resection (Paris classification 0-I, 0-II) in order to confirm the diagnosis and not compromise subsequent endoscopic resection.

Strong recommendation, low quality of evidence.

5 ESGE recommends obtaining two biopsies from the antrum and two from the corpus in patients with suspected Helicobacter pylori infection and for gastritis staging.

Strong recommendation, low quality of evidence.

6 ESGE recommends biopsies from or, if endoscopically resectable, resection of gastric adenomas.

Strong recommendation, moderate quality of evidence.

7 ESGE recommends fine-needle aspiration (FNA) and fine-needle biopsy (FNB) needles equally for sampling of solid pancreatic masses.

Strong recommendation, high quality evidence.

8 ESGE suggests performing peroral cholangioscopy (POC) and/or endoscopic ultrasound (EUS)-guided tissue acquisition in indeterminate biliary strictures. For proximal and intrinsic strictures, POC is preferred. For distal and extrinsic strictures, EUS-guided sampling is preferred, with POC where this is not diagnostic.

Weak recommendation, low quality evidence.

9 ESGE suggests obtaining possible non-neoplastic biopsies before sampling suspected malignant lesions to prevent intraluminal spread of malignant disease.

Weak recommendation, low quality of evidence.

10 ESGE suggests dividing EUS-FNA material into smears (two per pass) and liquid-based cytology (LBC), or the whole of the EUS-FNA material can be processed as LBC, depending on local experience.

Weak recommendation, low quality evidence.

Table 1 s



Publication History

Article published online:
17 September 2021

© 2021. European Society of Gastrointestinal Endoscopy. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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