March 14th, 2014
Dysphagia and Normal Endoscopy – Should We Biopsy Everyone?
The “discovery” of eosinophilic esophagitis (EoE) has added immensely to our understanding of many patients with dysphagia, and when endoscopic signs are present (furrowing, rings, white nodules, etc.), we should always confirm the diagnosis with endoscopic biopsies. However, many patients with EoE have a normal-appearing esophageal mucosa, and EoE would remain undetected if biopsies were not obtained. This concept has led many endoscopists to now routinely obtain endoscopic esophageal biopsies in all patients with dysphagia. I admit that this has become my predominant practice as well.
What are you doing in your practices?
More specifically …
- Do you routinely biopsy the esophagus in patients with dysphagia and an esophagus that appears normal?
- If yes, where do you biopsy, how many biopsies do you take, and how often are findings positive in these patients?
- If no, do you perform any other diagnostic tests in these patients with a normal-appearing esophagus (e.g., barium pill swallows, esophageal motility studies, etc.)?
9 Responses to “Dysphagia and Normal Endoscopy – Should We Biopsy Everyone?”
M. Brian Fennerty, MD
Editor-in-Chief
NEJM Journal Watch Gastroenterology
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I Only biopsy when I find endoscopic abnormalities in the esophagus
I routinely biopsy a normal-looking oesophagus in dysphagia if younger than 40 years old.
I take a couple of biopsies in distal oesophagus and a couple in mid-oesophagus into separate bottles.
I occasionally send for an oesophageal motility study.
I routinary take biopsy of normal appearing esophageal mucosa only in dysphagic young males, in particular if they report a history of food impaction/urgent endoscopic bolus removal
1. Almost routinely
2. 4-6 biopsies distal to upper 1/3
3. Ba swallow usu next if Bx NAD
I always take biopsies on proximal, middle and distal esophagus in four cuadrants.
I do biopsy every patient with overt dysphagia. 2 fragments proximal and 2 distal.
1.- yes, still look for endoscopic features
2.- 9 byopsy 3-3-3 form upper, middle and lowe esophagus. findings 30% eosinofilia
I routinely biopsy the esophagus in patients with dysphagia and an esophagus that appears normal. At least 3 or 4 biopsies and with most often negative results .
The other point would be in what conservative product do you transport the specimens : for the time being I use formol that is recommandated in France.
With negative findings and taking into account the age and history of the patient, I perrform other diagnostic tests in these patients with a normal-appearing esophagus (e.g., barium transit, esophageal motility studies, etc.)?
Always take biopsy. From 5 cm above GEjn.4 specimens.
Positive in appx 15-20%of times