Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 28, 2015; 21(12): 3607-3613
Published online Mar 28, 2015. doi: 10.3748/wjg.v21.i12.3607
Endoscopic ultrasound-guided deep and large biopsy for diagnosis of gastric infiltrating tumors with negative malignant endoscopy biopsies
Xin-Xin Zhou, Hang-Hai Pan, Ali Usman, Feng Ji, Xi Jin, Wei-Xiang Zhong, Hong-Tan Chen
Xin-Xin Zhou, Ali Usman, Feng Ji, Xi Jin, Hong-Tan Chen, Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Hang-Hai Pan, Department of Gastroenterology, Zhejiang Provincial People’s Hospital，Hangzhou 310014, Zhejiang Province, China
Wei-Xiang Zhong, Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Author contributions: Ji F and Zhou XX designed the research; Zhou XX, Usman A, Ji F, Zhong WX and Chen HT performed the research; Zhou XX and Jin X analyzed the data; Zhou XX, Usman A and Pan HH wrote the paper; all authors have read and approved the final version to be published.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Feng Ji, MD, PhD, Professor, Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. jifeng_1126@126.com
Telephone: +86-571-87236568 Fax: +86-571-87236611
Received: September 16, 2014
Peer-review started: September 18, 2014
First decision: October 29, 2014
Revised: December 3, 2014
Accepted: January 21, 2015
Article in press: January 21, 2015
Published online: March 28, 2015
Abstract

AIM: To assess the diagnostic yield and safety of a deep and large biopsy technique under the guidance of endoscopic ultrasound (EUS) for diagnosis of gastric infiltrating tumors with negative malignant endoscopy biopsies.

METHODS: From January 2009 to March 2014, 36 patients in whom gastric infiltrating tumors had been diagnosed by EUS received negative results for malignancy after endoscopic biopsies. The deep and large biopsy technique combined bite-on-bite technique with or without endoscopic mucosal resection (EMR) to obtain submucosal tissue from lesions. EUS was used to select the appropriate biopsy sites. If the lesion protruded into the cavity, EMR was performed for removal of the overlying mucosa and then bite-on-bite technique was conducted in the resected area to obtain submucosal tissue. If the lesion appeared to be flat or was difficult to lift by injection, the bite-on-bite technique was directly used.

RESULTS: Twenty-eight of the 36 patients were treated by EMR followed by bite-on-bite technique, while 8 patients only underwent bite-on-bite technique. Histological results showed 23 of the 36 lesions were poorly differentiated adenocarcinomas, 2 diffuse large B cell lymphomas, 4 mucosa-associated lymphoid tissue-type lymphomas, and 7 undiagnosed. The deep and large biopsy technique provided a definitive and conclusive diagnosis in 29 (80.6%) of the 36 patients. The 12 gastric linitis plastica and 6 lymphoma patients received chemotherapy and avoided surgery. Minor oozing of blood in 2 mucosal resection wounds was managed by argon plasma coagulation and in 5 cases after deep biopsies by epinephrine (0.001%). Neither severe hemorrhage nor perforation occurred in any patient.

CONCLUSION: The deep and large biopsy technique is superior to ordinary endoscopic biopsy for achieving an accurate diagnosis of gastric infiltrating tumors. This procedure guided by EUS is an effective and safe diagnostic method for gastric infiltrating tumors in which endoscopic biopsy results were negative for malignancy.

Keywords: Endoscopic ultrasonography, Endoscopic biopsy, Diagnosis, Gastric linitis plastica, Gastric lymphoma

Core tip: The diagnosis of gastric infiltrating tumors is challenging, which is often delayed due to negative endoscopic and histological tests. We for the first time investigated the deep and large biopsy technique for diagnosis of gastric infiltrating tumors with negative malignant endoscopy biopsies. This biopsy technique combined bite-on-bite technique with or without endoscopic mucosal resection. Endoscopic ultrasound was used to select the thickest site for biopsy. The biopsy provided a definitive and conclusive diagnosis in 29 (80.6%) of the 36 patients. Neither severe hemorrhage nor perforation occurred. It is an effective and safe diagnostic method for gastric infiltrating tumors with negative endoscopy biopsies.