Comparison of Filter Paper and Gelfoam as Templates for Orientation of Endoscopic Duodenal Biopsies

Abstract

Introduction: Proper orientation of endoscopic mucosal biopsies is crucial for accurate histomorphologic assessment. Aim: To compare the morphology on two different templates, filter paper and gelfoam for orientation of biopsies. Materials and Methods: In this study a total of 21 duodenal biopsies were studied which were taken from the same site, fixed and oriented on wet filter paper and gelfoam in formalin, from patients who presented with malabsorptive symptoms. Histomorphological parameters studied were villous architecture, crypt architecture, intraepithelial lymphocyte (IEL) count per 100 enterocytes, villous tip IEL count per 20 enterocytes, inflammatory cells in lamina propria. Statistical analysis was done using IBM- SPSS software version 21. p-value <0.05 was considered as statistically significant. Results: Twenty-one biopsies were taken in both the templates. Authors had 18 biopsies for analysis as three sections on gelfoam were lost during processing. All the histomorphological parameters were studied and it was similar on both the templates. The level of agreement by kappa statistics was significant with kappa value of 0.727 for villous architecture, 0.852 for lamina propria inflammatory infiltrate, 1 for IEL and eosinophils in lamina propria with p-value of <0.001. Conclusion: Authors concluded, gelfoam or filter paper serves as a good template for proper orientation of tiny mucosal biopsies. However, further studies are needed on larger sample size to validate this finding.

Keywords

• endoscopic mucosal biopsies
• gastrointestinal endoscopies
• lamina propria