Taking insufficient, excessive or inadequate biopsy samples
In the context of managing chronic gastritis, the correct number of adequate biopsies must be taken during endoscopy to detect H. pylori, and to stage chronic gastritis and atrophic changes if a neoplasia is found. Further biopsies indicated should be taken from the antrum and corpus because there is indirect evidence from surgical samples that distribution is patchy in the corpus and that, with age and expansion of pyloric glands, a distal-to-proximal gastric spread of H. pylori occurs.3 As a first conclusion, biopsy samples should be taken to detect whether H. pylori is present.
The need to take adequate and sufficient biopsy samples also applies to the staging of atrophic changes, as already determined. Biopsies are required to stage chronic gastritis if it is unestablished. However, importantly, once a risk phenotype has been established, biopsy samples no longer need to be taken provided the endoscopist has undergone proper training in endoscopic assessment of the gastric mucosa, except if there is a noticeable need to diagnose H. pylori infection.
Unfortunately, some individuals being managed due to chronic gastritis will harbour a lesion that is suspicious for neoplasia. In this case, it should be sampled adequately but not excessively. Early gastric neoplasia is best staged and then treated by endoscopic resection. Thus, taking extensive biopsy samples can jeopardize any subsequent endoscopic resection by inducing scarring and submucosal fibrosis. Therefore, for suspected neoplastic gastric lesions that are potentially amenable to endoscopic resection, the number of endoscopic biopsies taken should be limited.3 On the other side, for lesions that appear to be advanced when viewed endoscopically at least six biopsies should be taken.
In conclusion, when assessing the gastric mucosa via biopsy samples an integrated approach must be implemented to stage atrophic changes and to determine the nature of any neoplastic lesions, while not excluding the potential for minimal invasive therapy to be performed.
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