Intestine Biopsy - Small <1cm

Biopsy

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GI mucosal tissue histology.

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Intestine Biopsy - Small <1cm

Why is it done?
- Detects and diagnoses mucosal abnormalities in the small intestine, including inflammation, infection, and malabsorption disorders
- Diagnoses celiac disease by identifying villous atrophy and intraepithelial lymphocytes
- Evaluates chronic diarrhea, unexplained weight loss, and nutritional deficiencies
- Identifies infectious organisms such as parasites, bacteria, and fungal pathogens causing gastrointestinal disease
- Diagnoses inflammatory bowel disease (Crohn's disease, ulcerative colitis) and differentiates from other causes of inflammation
- Detects pre-malignant and malignant lesions or polyps during endoscopy
- Performs during capsule endoscopy or enteroscopy when abnormalities are visualized
- Evaluates immunoproliferative disorders and lymphomas of the small intestine
Normal Range
- Normal histology shows intact intestinal mucosa with normal villous architecture, crypts of Lieberkühn, and appropriate lamina propria cellularity
- Normal villus-to-crypt ratio of approximately 3-5:1 (villi three to five times taller than crypts)
- Intraepithelial lymphocytes (IELs) present in normal amounts: fewer than 20-30 lymphocytes per 100 epithelial cells
- Absence of inflammation in lamina propria with normal distribution of plasma cells and lymphocytes
- No visible organisms, parasites, or abnormal cellular infiltrates
- Normal mucosa with intact epithelial surface and no evidence of ulceration, bleeding, or necrosis
- Interpretation: Negative or 'benign' result indicates healthy intestinal tissue with no pathological findings
Interpretation
- Villous Atrophy: Decreased or flattened villi with increased intraepithelial lymphocytes; characteristic of celiac disease, tropical sprue, or severe malabsorption; also seen in Whipple's disease and lymphoma
- Increased Intraepithelial Lymphocytes (IELs): >40 lymphocytes per 100 epithelial cells indicates autoimmune enteropathy, celiac disease, or infectious colitis
- Lamina Propria Inflammation: Increased plasma cells, lymphocytes, and eosinophils; indicates Crohn's disease, ulcerative colitis, or infectious gastroenteritis
- Eosinophilic Infiltration: Increased eosinophils (>20 per high power field) suggests eosinophilic enteritis, food allergy, or parasitic infection
- Crypt Distortion: Elongated or hyperplastic crypts indicate chronic inflammation, inflammatory bowel disease, or tropical sprue
- Parasitic Organisms: Identification of Giardia, hookworm, tapeworm, or strongyloides indicates parasitic infestation requiring anthelmintic therapy
- Bacterial Overgrowth: Increased bacterial colonization on epithelial surface; associated with small intestinal bacterial overgrowth (SIBO) or compromised mucosal immunity
- Dysplasia or Malignancy: Low-grade or high-grade dysplasia; indicates increased cancer risk and requires close surveillance and possible intervention
- Granulomas: Non-caseating granulomas suggest Crohn's disease, while caseating granulomas indicate tuberculosis or fungal infection
- Whipple's Disease: PAS-positive, diastase-resistant macrophages in lamina propria; indicates Tropheryma whipplei infection requiring antibiotic treatment
- Factors Affecting Results: Specimen size (<1cm), sampling location, fixation quality, patient preparation, and concurrent medications (immunosuppressants, NSAIDs) may affect interpretation
Associated Organs
- Primary Organ System: Small intestine (duodenum, jejunum, ileum); gastrointestinal and digestive system
- Associated Medical Conditions (Abnormal Results):
- Celiac disease (tissue transglutaminase antibodies)
- Crohn's disease and ulcerative colitis
- Small intestinal bacterial overgrowth (SIBO)
- Whipple's disease and other infectious enteritis
- Giardiasis and parasitic infections
- Tropical sprue and nutritional deficiencies
- Eosinophilic enteritis and food allergies
- Intestinal lymphoma and gastrointestinal malignancies
- Autoimmune enteropathy and immunodeficiency disorders
- Tuberculosis and atypical mycobacterial infections
- Potential Complications of Abnormal Results:
- Malabsorption and severe nutritional deficiencies (vitamin B12, folate, iron, fat-soluble vitamins)
- Chronic diarrhea with dehydration and electrolyte imbalances
- Intestinal perforation or bleeding from severe inflammation or malignancy
- Intestinal obstruction from strictures, polyps, or tumors
- Fistula formation in Crohn's disease
- Progression to malignancy if dysplasia is identified
- Systemic complications including anemia, osteoporosis, and delayed growth in children
Follow-up Tests
- Based on Specific Biopsy Findings:
- Celiac disease diagnosis: Tissue transglutaminase (tTG-IgA) and endomysial antibodies; genetic testing for HLA-DQ2/DQ8; repeat endoscopy at 1-2 years on gluten-free diet
- Inflammatory bowel disease: C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fecal calprotectin, colonoscopy with additional biopsies
- Parasitic infection: Stool ova and parasite examination; serology for specific parasites; treatment efficacy testing at 2-4 weeks post-treatment
- Whipple's disease: PCR testing for Tropheryma whipplei; CSF examination if CNS involvement suspected; follow-up testing at 1 week and 3 months post-treatment
- Small intestinal bacterial overgrowth: Hydrogen breath test, lactulose breath test, or glucose breath test
- Dysplasia or malignancy: Complete blood count, metabolic panel, tumor markers (CEA, CA 19-9), CT/MRI imaging, endoscopic ultrasound, oncology consultation
- Eosinophilic enteritis: Allergy testing (skin prick test, specific IgE), dietary elimination trials, assessment for systemic eosinophilia
- Nutritional and Metabolic Assessment:
- Complete blood count for anemia; iron studies (ferritin, TIBC); vitamin B12 and folate levels
- Fat-soluble vitamin levels (vitamins A, D, E, K); prealbumin and albumin for protein status
- 72-hour fecal fat test if steatorrhea suspected; prothrombin time (PT/INR) for vitamin K assessment
- Imaging and Monitoring:
- Video capsule endoscopy for evaluation of obscure gastrointestinal bleeding or multiple lesions
- MR enterography or CT enterography for evaluation of inflammatory disease extent and complications
- Repeat endoscopy with biopsy at 1-2 years for celiac disease on diet, dysplasia surveillance for high-risk patients
- Monitoring Frequency:
- Celiac disease: Annual serology after diagnosis; repeat endoscopy at 2 years if non-responsive
- IBD: Every 6-12 months with laboratory studies; colonoscopy every 1-3 years depending on disease activity
- Dysplasia/malignancy: Every 3-6 months endoscopy initially, then annually if stable; imaging every 6-12 months
Fasting Required?
- Yes, fasting is required.
- Fasting Duration: Minimum 6-8 hours before the procedure; typically overnight fasting is recommended for morning procedures
- Fluid Intake: Clear fluids (water, juice without pulp, broth) may be allowed up to 2-3 hours before procedure; specific instructions from endoscopy center should be followed
- Medications to Avoid or Modify:
- Aspirin and NSAIDs: Avoid 5-7 days prior to procedure due to bleeding risk
- Anticoagulants (warfarin, dabigatran): Discuss with physician; may need to discontinue 3-5 days prior; check INR
- Clopidogrel and ticlopidine: Usually discontinued 7-10 days prior unless high-risk cardiac stent requires continuation
- Iron supplements: Discontinue 3-5 days prior (causes black discoloration of intestine)
- Bismuth subsalicylate: Avoid 5-7 days prior
- Most other medications: Continue as normal; take with small sip of water if necessary
- General Patient Preparation Instructions:
- Bowel preparation: Polyethylene glycol (PEG) solution, sodium phosphate, or magnesium citrate may be required; typically initiated 12-24 hours before procedure
- Consent and allergies: Review informed consent; disclose all allergies, particularly to medications and contrast agents
- Sedation planning: Arrange transportation as conscious sedation (midazolam, propofol) or general anesthesia will be used; patient cannot drive for 24 hours
- Arrival time: Arrive 30 minutes early for check-in and vital signs monitoring
- Comfortable clothing: Wear loose, comfortable clothing that can be removed easily
- Post-procedure restrictions: Nothing by mouth until full recovery from anesthesia; solid foods avoided for 2-4 hours post-procedure; rest for 24 hours

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