Muzzle-loaded jumbo biopsy at gastroscopy
P.B. COTTON
Department of Gastroenterology, The Middlesex Hospital, London WI (U.K.)
La biopsie gastrique a pince large doublement appareillee
SUMMARY
A new method of gastric biopsy is described, providing larger and deeper specimens. The jumbo forceps, the cups of which are too large to pass through a current gastroscope, must be muzzle-loaded and passed through a protecting tube. The procedure is devoted mainly to patients with large gastric folds or mass lesions, only after negative standard endoscopic biopsies.
RESUM[~
L'auteur d{crit zme mdthode de bh~psie gastrique utifisant nne pince it larges cuill~res non destinde tJ I'introduction dans le canal h biopsie d'un gastroscope standard. La pince est introdaite par vole r~trograde at, ant I'examen et nOcessite t'emploi d'an tube protecteur. Les biopsies plus larges et plus profimdes ne sent prdlev~es qu'en deuxibme intention, apr~s biopsies standards n~gatives chez des patients porteurs de gros plis ou de masses gastriqaes.
INTROD UCTION
Standard endoscopic forceps biopsies usually provide sufficient material for the diagnosis of gastric mucosal pathology, but rarely sample deeper lesions. We describe a method for taking larger and deeper specimens, with jumbo forceps whose cups are far too large to pass through an endo- scope channel. The forceps are muzzle loaded, and passed through a protecting overtube.
METHOD
The technique is used only after standard endo- scopic biopsy methods have failed to provide a diagnosis, and mainly in patients with large gastric folds or mass lesions. The jumbo forceps (fig. 1) have cups of 5 mm diameter, 8 mm length, and 10 mm spread. The controlling handle is detacha- ble. A standard forward viewing fibrescope is passed in the usual way, with an overtube at its hilt (fig. 2), The lesion is examined, and further specimens are taken with standard biopsy forceps.
The endoscope is then withdrawn, leaving the overtube in place, to protect the pharynx and oesophagus during subsequent manoeuvres. The handle of the jumbo forceps is detached, and the cable is passed retrogradely through the endo-
Figure 1
Jumbo forceps closed and open (left and middle) : comparison with standard forceps (right~
Vue de la pince . j u m b o , ouverte et fermee ; comparaison avecla pince standard
scope channel. The tip of the endoscope (with the biopsy cups projecting) (fig. 3) is passed through the overtube, and then advanced through the cardia under direct vision. Multiple biopsy specimens are taken by passing the endoscope (and contai- ning forceps) repeatedly through the overtube,
Address for reprints : P.B. COTTON, Department of Gastro- enterology. The Middlesex Hospital. London WI (U.K.).
Key-words . endoscopy, gastric biopsy, submucosal lesions.
Mots-cl~s: biopsie gastrique, endoscopie, 16sions sous-mu- queuses.
Acta Endoscopica Volume 13 - N" I - 1983 71
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