Lamina Propria Yield Using Perpendicular Placement of Standard Capacity Biopsy Forceps in Pediatric Eosinophilic Esophagitis
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INTRODUCTION: Pediatric patients with eosinophilic esophagitis (EoE) often lack fibrostenotic features. Identifying esophageal lamina propria (LP) fibrosis has become a method of identifying early remodeling. We have previously shown that biopsies obtained by standard capacity Radial JawTM 4 forceps often lack adequate LP in EoE cases. The purpose of this study was to: 1) evaluate the LP yield in pediatric EoE cases using a standardized technique consisting of perpendicular placement of the forcep, suction, and single bite; 2) evaluate the relationships between esophageal level, LP yield, intraepithelial eosinophilia, and fibrosis. METHODS: We reviewed consecutive EoE endoscopic cases performed by a single endoscopist using the sampling technique described above from 1/1/2018 to 12/31/2018. For each case, the same number of biopsies was taken from each level. Archived H&E slides had consensus evaluation by two study pathologists to determine the peak intraepithelial eosinophil count per high power field, LP adequacy, and LP fibrosis of each biopsy tissue fragment. RESULTS: The endoscopist took 237 biopsies from 30 cases; due to tissue fragmentation during histology processing, 255 biopsy tissue fragments were analyzed. Overall, 21 (70%) cases had at least 1 fragment with adequate LP, however only 86 (34%) fragments had adequate LP. Active EoE (≥ eos/HPF) cases were more likely to have fibrosis detected, while inactive EoE (<15 eos/HPF) cases were more likely to be inadequate. Fragments from active EoE cases demonstrated significantly higher rates of adequate LP than inactive cases. There were no significant differences in adequate LP yield per fragment among the 3 levels of the esophagus. However, fragments from the distal and middle esophagus had significantly higher eosinophilia than the proximal esophagus. Fibrosis was patchy andmost often detected in the mid-distal esophagus in the 13 EoE cases with fibrosis. Fragments with adequate LP had significantly higher eosinophilia than those with inadequate LP (25±30 vs. 14±23 eos/HPF, p<0.0001). Fragments with LP fibrosis demonstrated significantly higher eosinophilia than those with normal LP or inadequate LP (36±34, 11±16, 14±23 eos/HPF, respectively, p<0.0001). CONCLUSION: LP yield per biopsy tissue fragment using a perpendicular placement of forcepsis low. Both adequate LP and fibrosis are associated with higher esophageal eosinophilia, and esophageal eosinophilia is higher in the middle and distal esophagus. Thus, sampling from the middle-distal esophagus might optimize detection of fibrosis in pediatric EoE.
The 58th Annual Medical Student Research Forum at UT Southwestern Medical Center (Tuesday, January 21, 2020, 3-6 p.m., D1.600)
Pham, V. H., Thaker, A., Troendle, D., Goyal, A., Parrish, C., Medina, A., . . . Cheng, E. (2020, January 21). Lamina propria yield using perpendicular placement of standard capacity biopsy forceps in pediatric eosinophilic esophagitis. Poster session presented at the 58th Annual Medical Students Research Forum, Dallas, TX. Retrieved from https://hdl.handle.net/2152.5/8269