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Endoscopy 2021; 53(03): 246-253
DOI: 10.1055/a-1201-3125
Original article

Single-bite versus double-bite technique for mapping biopsies during endoscopic surveillance for hereditary diffuse gastric cancer: a single-center, randomized trial

Apostolos Pappas‡   *
1   MRC Cancer Unit, University of Cambridge, Cambridge, UK
,
Wei Keith Tan‡   *
1   MRC Cancer Unit, University of Cambridge, Cambridge, UK
2   Department of Gastroenterology, Addenbrookes Hospital, Cambridge University NHS Foundation Trust, Cambridge, UK
3   Department of Gastroenterology, Hinchingbrooke Hospital, Huntingdon, UK
,
William Waldock
1   MRC Cancer Unit, University of Cambridge, Cambridge, UK
,
Susan Richardson
4   Department of Oncology, Addenbrookes Hospital, Cambridge University NHS Foundation Trust, Cambridge, UK
,
Monika Tripathi
5   Department of Histopathology, Addenbrookes Hospital, Cambridge University NHS Foundation Trust, Cambridge, UK
,
Wladyslaw Januszewicz
1   MRC Cancer Unit, University of Cambridge, Cambridge, UK
6   Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Center for Postgraduate Education, Warsaw, Poland
,
Geoffrey Roberts
7   Department of Surgery, Addenbrookes Hospital, Cambridge University NHS Foundation Trust, Cambridge, UK
,
Maria O'Donovan
5   Department of Histopathology, Addenbrookes Hospital, Cambridge University NHS Foundation Trust, Cambridge, UK
,
Rebecca C. Fitzgerald
1   MRC Cancer Unit, University of Cambridge, Cambridge, UK
,
Massimiliano di Pietro
1   MRC Cancer Unit, University of Cambridge, Cambridge, UK
› Author AffiliationsTrial registry: Clinical.Trials.gov | Registration number (trial ID): NCT03950908 | Type of study: single center, randomized trial.
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Author commentary on Apostolos Pappas et al.Endoscopy 2021; 53(03): v13-v13
DOI: 10.1055/a-1215-8779

Abstract

Background Endoscopic surveillance is recommended in patients with hereditary diffuse gastric cancer (HDGC) who refuse or want to delay surgery. Because early signet-ring cell carcinoma (SRCC) can be inconspicuous, the current surveillance endoscopy protocol entails 30 random biopsies, which are time-consuming. This study aimed to compare single-bite and double-bite techniques in HDGC surveillance.

Methods Between October 2017 and December 2018, consecutive patients referred for HDGC surveillance were prospectively randomized to the single- or double-bite arm. The primary outcome was the diagnostic yield for SRCC foci. Secondary outcomes were: procedural time for random biopsies; comfort score; biopsy size; and quality of specimens, the latter assessed by the presence of muscularis mucosa, crush artifact, and proportion usable for diagnostic assessment.

Results 25 patients were randomized to the single-bite arm and 23 to the double-bite arm. SRCC foci were detected in three and four patients in the single- and double-bite arms, respectively (P = 0.70). The procedural time for the double-bite arm (12 minutes, interquartile range [IQR] 4) was significantly shorter than for the single-bite arm (15 minute, IQR 6; P = 0.01), but comfort scores were similar. The size of the biopsies in the double-bite arm was significantly smaller than in single-bite arm (2.5 mm vs. 3.0 mm; P < 0.001) but this did not affect the presence of muscularis mucosa (P = 0.73), artifact level (P = 0.11), and diagnostic utility (P = 0.051).

Conclusion For patients undergoing HDGC surveillance, the double-bite technique is significantly faster than the single-bite technique. The diagnostic yield for SRCC and the biopsy quality were similar across both groups.

* Joint first authors




Publication History

Received: 03 September 2019

Accepted: 26 May 2020

Article published online:
17 July 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
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