Jumbo Forceps Versus Standard Forceps for the Diagnosis of Inflammatory Bowel Disease

Abstract

Introduction: Inflammatory bowel disease is a chronic inflammatory disorder which is diagnosed based on histological findings. IBD patients also undergo regular colon biopsies for colon cancer surveillance. Jumbo forceps could increase the size and quality of biopsy samples compared to standard large-capacity forceps. Methods: We conducted a prospective cohort study of adult patients (age>/=18 years) who presented to the Henry Ford Hospital with clinical symptoms or known history of Inflammatory Bowel disease and were undergoing diagnostic or surveillance colonoscopy respectively. Patients who had a history of malignancy or were suspected of having Clostridium difficile infection were excluded. 24 patients were prospectively enrolled and paired random biopsy samples were obtained using the jumbo forceps and standard large capacity forceps. Specimens were obtained by expert endoscopists and reviewed by expert pathologist. Our primary outcome was adequacy of biopsy samples obtained with jumbo forceps compared to specimens obtained using the large capacity forceps. Results: There were 211 biopsy samples obtained using the standard forceps and 185 samples using the jumbo forceps. The proportion of biopsy samples with penetration into the muscularis mucosa was significantly higher with the jumbo forceps (70.21% vs 57.29%, p-value < 0.001). There was no significant crush artifact in any of the biopsy specimens. There was also no difference in the number of adequate biopsy samples obtained using jumbo forceps and large capacity forceps (95.83% vs 91.6%, p-value - 0.32) Conclusion: The jumbo forceps was superior to standard large-capacity forceps in obtaining adequate penetration into the muscularis mucosa without increasing crush artifact. The superior quality of biopsy specimens obtained by jumbo forceps could facilitate timely diagnosis as well as detection of dysplasia in IBD patients.Table 1