Prospective, Randomized, Pathologist-Blinded Study the Performance of Current Disposable Alligator-Jaw Biopsy Forceps for Gastric Mucosal Biopsies

Abstract

Background: Fiberoptic endoscopy with targeted biopsy is the primary diagnostic approach to most GI disorders. Biopsy specimens obtained at endoscopy help not only to differentiate benign from malignant diseases, but also to establish the precise nature of the abnormality, be it infectious, inflammatory, or neoplastic. Since the inception of endoscopy, innovations have taken place in the design of the biopsy forceps. As a result, a large variety of endoscopic biopsy forceps are commercially available that differ in the size of the biopsy cup, the shape of the cup and the presence or absence of a needle. Because endoscopic biopsy specimens provide information that is critical to patient care, the overriding factor when selecting the ideal forceps should be the adequacy of the tissues for histologic diagnosis. The null hypothesis was that there was no difference with regard to adequacy of samples GI mucosal samples obtained among current versions of “large cup” forceps with needles designed for 2.8 mm channels: Boston Scientific Radial Jaw 3, Large capacity (2.2 mm OD), ConMed Alligator Jaw (2.3 mm O.D.) and Olympus Endojaw (2.45 mm O.D.) (both with and without a needle). Methods: Two gastric biopsy specimens (one antral and one from the gastric corpus) will be obtained with each forceps (a total of 8 specimens per patient). The tissue samples examined included: weight (mg), length (mm), orientation (poor, good), intactness (1, 2, or 3 pieces), depth (superficial, above muscularis mucosa, included muscularis mucosa), crush artifact (yes, no), and overall adequacy (inadequate, suboptimal, adequate). Results: 24 patients were enrolled (191 biopsies). The median biopsy length was 5 mm and was similar for all forceps. Histologically inadequate specimens were obained in 4% with Endojaw without needle compared to 12.5%, 14.8%, and 18.7% for Radial Jaw, Endojaw with needle, and ConMed, respectively. However, crush artifact was twice as common with Endojaw without needle (33%) and with ConMed (29%) than with Radial Jaw or Endojaw with needle (12.5% and 17%, respectively). Conclusions: Alligator type forceps generally provide acceptable gastric mucosal biopsy specimens. ConMed forceps with needle had the highest rates of inadequate biopsies and biopsies with crush artifact. Disposable alligator-jaw forceps without needles provide histologically acceptable samples more frequently than those with needles.