Yield of tissue sampling for subepithelial lesions evaluated by endoscopic ultrasonography: a comparison between forceps biopsies and endoscopic submucosal resection

Background In most circumstances, subepithelial tumors lack distinct endoscopic and ultrasonographic features. Consequently, definitive diagnosis usually requires tissue acquisition and pathologic confirmation. Establishing a tissue diagnosis is difficult because the yield of forceps biopsies is low. However, prospective data evaluating tissue sampling techniques for subepithelial lesions are currently lacking. Objective Our purpose was to prospectively determine the diagnostic yield of endoscopic submucosal-mucosal resection (ESMR) compared with forceps biopsy for lesions limited to the submucosa (third endosonographic layer) of the gastrointestinal tract. Design A prospective head-to-head comparison was performed. Setting The study was performed in a tertiary care hospital. Patients Study patients were 23 adults with subepithelial lesions limited to the submucosa. Intervention All submucosal lesions underwent forceps biopsy followed by endoscopic submucosal resection. Biopsy speciments were obtained with large-capacity “jumbo” forceps. A total of 4 double passes (8 biopsy specimens) were collected from each lesion with use of the bite-on-bite technique. Endoscopic resection was then performed with an electrosurgical snare or cap-fitted endoscopic mucosal resection device. Main outcome measurement The main outcome measurement was the diagnostic yield of biopsy forceps compared with endoscopic submucosal resection Results Twenty-three patients with lesions limited to the submucosa were identified by endoscopic ultrasonography. All lesions underwent forceps biopsy followed by ESMR. The diagnostic yield of the jumbo forceps biopsy was 4 of 23 (17%), whereas the diagnostic yield of ESMR was 20 of 23 (87%) ( P = .0001, McNemar test). Conclusion In the evaluation of subepithelial lesions limited to the submucosa, ESMR has a significantly higher diagnostic yield than jumbo forceps biopsy with use of the bite-on-bite technique.