Colon biopsy. Why do you need a bowel biopsy?

All kinds of bowel diseases are found in both adult and pediatric practice. The proctologist is engaged in the treatment of the large intestine and nearby departments. And the small intestine is in the competence of the gastroenterologist. Histological and cytological studies play a leading role in the diagnosis of such diseases. Therefore, quite often, patients are prescribed an intestinal biopsy.

Main indications and contraindications

A biopsy in proctology and gastroenterology is done with suspicion of such pathological conditions:

• tumor formations;
• abnormal growth over the mucous membrane;
• ulcerative lesions of the large intestine on the background of protozoal infection;
• chronic autoimmune inflammation of the gastrointestinal tract;
• abnormal development of the large intestine, accompanied by persistent constipation;
• deposition of amyloid in the intestinal tissues;
• the presence of fistulas in the rectum;
• chronic ulcerative colitis;
• detection in the feces of impurities of blood and particles of mucus;
• too enlarged large intestine;
• narrowing of the lumen in the intestines.

Biopsy sampling of intestinal tissue is not performed in such cases:

• the rehabilitation period after a recent surgical intervention;
• the presence of severe pathologies of an infectious nature;
• inflammation of hernial protrusions of the walls of the small or large intestine;
• severe inflammatory diseases in terms of gynecology;
• inflammation of the peritoneum of the small pelvis;
• critical narrowing of the lumen in the intestines;
• severe forms of pulmonary and heart failure.

If the doctor prescribes a colonoscopy and a biopsy, then he has good reasons for this. The patient should not refuse such diagnostic measures. After all, the earlier and more correctly the diagnosis is established, the more chances there are for a favorable prognosis.

A single biopsy is usually sufficient, but in some cases, a second biopsy may be required.

Biopsy of the small intestine

If a person shows signs and symptoms of malabsorption or malnutrition, a doctor may suspect celiac disease. The most accurate method for diagnosing this disease is a biopsy of the small intestine.

Biopsy sampling is carried out with fibrogastroscopy. However, due to the tortuosity of the loops of the small intestine, the advancement of the probe is difficult and dangerous. So only the lower sections of the duodenum and its transition to the jejunum are subject to a thorough examination. The biopsy is taken only from the upper sections of the small intestine.

An innovative diagnostic method is. The patient is allowed to swallow a miniature-sized video camera closed in a capsule. In the course of its progress, not only the small intestine is successfully scanned, but also other components of the gastrointestinal tract. However, it is impossible to perform a biopsy by this method.

Biopsy of the large intestine

The structure of the large intestine allows you to fully examine it with an endoscopic probe and take a biopsy of material for further research. To do this, sigmoidoscopy is performed, during which it is possible to examine the rectum and sigmoid colon, as well as take a tissue sample or remove a polyp. The biopsy collected during the process is sent for histological analysis.

Before carrying out fibrocolonoscopy, barium enema is usually prescribed. This procedure involves an x-ray examination of the colon with a retrograde injection of a radiopaque preparation into it. Such manipulation allows you to present the overall picture, to see the state of the intestinal lumen, which will help prevent damage during the introduction of the probe.

Colonoscopy with biopsy can also be done in children. For this, a special children's fiberscope is used, under the preliminary administration of sedatives, and at an early age, short anesthesia can be applied for the duration of the procedure - 30-40 minutes.

The result that a biopsy of the colon gives helps to confirm or refute the malignant nature of the neoplasm. Histological studies help the doctor determine the extent of further surgical intervention or refuse it altogether.

Preparing for a biopsy

Taking a biopsy and subsequent histological examination shows the most accurate result, only if the patient is properly prepared and there is no content left in the lumen of the organ before the procedure.

Before a colonoscopy with a biopsy, they resort to such methods of bowel cleansing:

• cleansing enemas with warm water using Esmarch's mug;
• drug bowel cleansing (Fortrans);
• during the week, eat only light and refined foods.

Food must be avoided for 24 hours before the procedure. Drinking water is allowed.

If a biopsy is performed by a qualified specialist, then it turns out to be a completely safe and very informative procedure.

How is the procedure carried out

An intestinal biopsy can cause the patient to panic. Embarrassment is associated with fear of pain. To ensure, as far as possible, comfort during manipulation, one of the following types of anesthesia can be performed:

• General anesthesia. The patient is in an unconscious state.
• Local anesthesia. This method involves lubricating the tip of the colonoscope with an anesthetic.
• Treatment under sedation. Due to the introduction of tranquilizers, the patient is immersed in superficial sleep and loses pain fear.

There are two main ways to biopsy the colon:

• Blind aspiration- used for disseminated lesions of the large intestine.
• Sighting - carried out using endoscopic equipment. This technique is effective for diagnosing a granulomatous (nodular) inflammatory process or a chronic infectious disease caused by Mycobacterium tuberculosis.

The main tool for biopsy sampling - rectal biopsy forceps. They are inserted through an anoscope or rectoscope. As a rule, they are made of medical steel. At the end they have a spike and jagged edges of the spoon. The spike provides reliable localization and fixation of the forceps, and the serrated edges of the spoons produce effective capture and cutting off tissue parts for histology.

Since the procedure involves penetration into the body through natural external barriers, it must be performed very carefully. This will help to avoid damage to the walls and pathological areas, as well as the appearance of bleeding against the background of this.

An intestinal biopsy is a diagnostic procedure that has the highest accuracy of results. It is important to conduct it in a timely manner in order to identify serious diseases at an early stage. It plays a decisive role in choosing the right treatment course and its success. In some cases, this procedure can actually save a life.

Due to the length (4-5 m in tone) and the presence of a large number of loops, intestinal diseases cannot always be diagnosed with hardware methods. Doctors often turn to traditional bowel biopsy. The procedure is complex and involves the collection of biological material and / or intestinal cells for examination under a microscope and diagnosis. It is often used to confirm / refute ulcerative colitis, Crohn's pathology, cancer.

The need for a thorough study of the state of the intestine is realized by conducting a biopsy.

What is it and what does it show?

An intestinal biopsy is a three-step procedure:

1. a special instrument is inserted into the lumen of the organ;
2. a small piece of living tissue is taken with tweezers or other instrument;
3. the biopsy is examined under a microscope in the laboratory.

The procedure belongs to the group of minimally invasive endoscopic techniques (gastroscopy, colonoscopy, colposcopy) performed using a probe.

The main goal of a biopsy is to make an accurate diagnosis, when it is impossible to do this with other methods (even the most modern ones). The main advantage is the visual examination of living tissues from the site of intestinal damage in the histopathological laboratory. Therefore, with the help of the procedure, it is possible to establish the nature of the pathology, assess the malignancy or benignity of the neoplasm, the extent of inflammation, etc.

Usually, a biopsy is performed one-time, but if negative results are obtained regarding the malignancy of the process, repeated sampling of the biopsy may be required. The results shown by the study of the biomaterial make it possible to prescribe the correct treatment.

There are several types of intestinal biopsy, depending on how the biopsy is performed and taken:

1. incisional, when the selection is made during the abdominal operation;
2. puncture, when a special needle is used to take a biopsy, inserted through the skin and walls of the organ;
3. scarifying, when scraping is performed;
4. trepanation - with the sampling of material with a special hollow tube, at the end of which there are sharp edges;
5. pinched - using special tongs;
6. loop, when a special metal loop with a coagulator is used.

To identify the type and nature of the pathology, its degree of prevalence and stage of development, biopsy colonoscopy of the intestine is more often performed using a pinch or loop method.

Depending on the objectives of the examination, an intestinal biopsy can be performed using additional instruments or different methods.

Also, depending on the stage of the pathology, they use:

• sighting technique - the selection of tissues from the site of a previously detected and diagnosed pathology;
• search technique - sampling of material when a suspicious area is detected during the examination of the intestinal lumen.

Taking a biopsy is always done during a colonoscopy (endoscopic examination with a probe). Often the decision is made suddenly, that is, when a doctor detects suspicious areas. It is undesirable to refuse the procedure, since this method allows you to accurately confirm or refute the presence of a serious pathology at an early stage and start treatment in a timely manner. In this case, the therapeutic prognosis will always be favorable.

Indications

The need for a biopsy for pathohistological and cytological analysis of the biomaterial is dictated by the presence of suspicions for such pathologies and conditions:

• tumor neoplasms, polyps;
• narrowing of the intestinal lumen, revealed on the radiograph;
• persistent bowel dysfunction, manifested by chronic constipation, bloating;
• detection of particles of mucus and / or blood impurities in the feces;
• ulcerative type;
• autoimmune inflammation of the intestinal wall (Crohn's syndrome);
• suspicion of anomalies in the development of the intestine, for example, when the large intestine is too enlarged;
• detection of rectal fistulas.

Contraindications

Despite the advantages of the method, there are contraindications regarding its use, such as:

1. Absolute:

• an increase in the colon of a toxic nature;
• severe conditions;
• the rehabilitation period after a recent bowel operation;
• diverticulitis;
• severe inflammation of the fallopian tubes and ovaries in women;
• pelvic peritonitis;
• severe infectious diseases.

1. Relative:

• partial stenosis;
• severe forms of pulmonary or cardiac dysfunction.

Training

Preparing for a colonoscopy biopsy should be like an operation - an early and thorough bowel cleansing. No contents should remain in the lumen of the organ, since even traces can cover small areas of just begun ulceration, formed polyps or tumors.

Modern methods of bowel cleansing:

1. Cleansing enemas with warm water using Esmarch's mug.
2. Medical cleaning, for example, "Fortrans". The effectiveness of the drug is higher than that of several enemas. In this case, the procedure does not bring discomfort. Before use, a doctor's consultation is required, who will select the dosage in accordance with the characteristics of the examined intestine (thick, thin, straight).
3. Slag-free diet based on the consumption of refined and light food during the week before the examination. The day before the session, you should drink only water.

How is the procedure carried out?

Biopsy sampling is carried out using a colonoscope inserted into the anus. To ensure maximum patient comfort, three types of anesthesia are offered:

• complete - with immersion in sleep and a complete shutdown of consciousness;
• local - the tip of the colonoscope is lubricated with an anesthetic ("Lidocaine"), which ensures painless movement of the device through the intestinal lumen;
• sedation - intravenous administration of tranquilizers to immerse the patient in superficial sleep.

The selected pieces of living tissue are sent to the laboratory for pathohistological and cytological analyses. The approach to biopsy sampling varies depending on the part of the intestine being examined.

“You need to take a biopsy” - many have heard this phrase from the attending physician. But why is it needed, what does this procedure give and how is it carried out?

concept

A biopsy is a diagnostic study that involves the sampling of biomaterial from a suspicious area of ​​\u200b\u200bthe body, for example, compaction, tumor formation, a long-term non-healing wound, etc.

This technique is considered the most effective and reliable among all those used in the diagnosis of oncological pathologies.

Photo of breast biopsy

• Thanks to the microscopic examination of the biopsy, it is possible to accurately determine the cytology of tissues, which provides complete information about the disease, its degree, etc.
• The use of a biopsy allows you to identify the pathological process at its earliest stage, which helps to avoid many complications.
• In addition, this diagnosis allows you to determine the extent of the upcoming operation in cancer patients.

The main task of a biopsy is to determine the nature and nature of pathology tissues. For a detailed diagnosis, a biopsy study is supplemented with X-ray water, immunological analysis, endoscopy, etc.

Kinds

Biomaterial sampling can be done in different ways.

1. - a technique for obtaining a biopsy using a special thick needle (trephine).
2. excisional biopsy - a type of diagnosis in which the entire organ or tumor is removed during surgery. It is considered a large-scale type of biopsy.
3. Puncture– This biopsy technique involves obtaining the necessary samples by puncture with a fine needle.
4. Incisional. Removal affects only a certain part of the organ or tumor and is carried out in the process of a full-fledged surgical operation.
5. stereotactic- a minimally invasive diagnostic method, the essence of which is to build a specialized access scheme to a specific suspicious area. Access coordinates are calculated based on the pre-scan.
6. Brush biopsy- a variant of the diagnostic procedure using a catheter, inside which a string with a brush is inserted, collecting a biopsy. This method is also called the brush method.
7. Fine needle aspiration biopsy- a minimally invasive method in which the material is taken using a special syringe that sucks the biomaterial from the tissues. The method is applicable only for cytological analysis, since only the cellular composition of the biopsy is determined.
8. Loopback biopsy - a biopsy is taken by excising pathological tissues. The desired biomaterial is cut off by a special loop (electrical or thermal).
9. Transthoracic biopsy is an invasive diagnostic method used to obtain biomaterial from the lungs. It is carried out through the chest in an open or puncture way. Manipulations are carried out under the supervision of a videothoracoscope or computed tomography.
10. Liquid biopsy is the latest technology for detecting tumor markers in liquid biopsy, blood, lymph, etc.
11. Radio wave. The procedure is carried out using specialized equipment - the Surgitron apparatus. The technique is gentle, does not cause complications.
12. open- this type of biopsy is carried out using open access to the tissues, the sample of which needs to be obtained.
13. Preskalennaya biopsy - a retroclavicular study in which the biopsy is taken from the supraclavicular lymph nodes and lipid tissues at the angle of the jugular and subclavian veins. The technique is used to detect pulmonary pathologies.

Why is a biopsy done?

A biopsy is indicated in cases where, after other diagnostic procedures, the results obtained are not enough to make an accurate diagnosis.

Usually, a biopsy is prescribed when detected to determine the nature and type of tissue formation.

This diagnostic procedure is now successfully used to diagnose many pathological conditions, even non-oncological ones, since in addition to malignancy, the method allows you to determine the degree of spread and severity, stage of development, etc.

The main indication is to study the nature of the tumor, however, often a biopsy is prescribed to monitor ongoing oncology treatment.

Today, it is possible to obtain a biopsy from almost any area of ​​the body, and the biopsy procedure can perform not only a diagnostic, but also a therapeutic mission, when the pathological focus is removed in the process of obtaining a biomaterial.

Contraindications

Despite all the usefulness and highly informative technique, a biopsy has its own contraindications:

• The presence of blood pathologies and problems associated with blood clotting;
• Intolerance to certain drugs;
• Chronic myocardial insufficiency;
• If there are alternative non-invasive diagnostic options with similar information content;
• If the patient refuses to undergo such a procedure in writing.

Material research methods

The resulting biomaterial or biopsy is subjected to further research, which takes place using microscopic technologies. Usually, biological tissues are sent for cytological or histological diagnostics.

Histological

Sending a biopsy for histology involves microscopic examination of tissue sections, which are placed in a specialized solution, then in paraffin, after which staining and sections are performed.

Staining is necessary so that the cells and their parts are better distinguished by microscopic examination, on the basis of which the doctor draws up a conclusion. The patient receives the results in 4-14 days.

Sometimes a histological examination needs to be done urgently. Then the biomaterial is taken during the operation, the biopsy is frozen, and then sections are made and stained in a similar way. The duration of such an analysis is no more than 40 minutes.

Doctors have a rather short period of time to determine the type of tumor, decide on the volume and methods of surgical treatment. Therefore, in such situations, urgent histology is practiced.

Cytological

If histology was based on the study of tissue sections, then it involves a detailed study of cellular structures. A similar technique is used if it is not possible to obtain a piece of tissue.

Such a diagnosis is carried out mainly in order to determine the nature of a particular formation - benign, malignant, inflammatory, reactive, precancerous, etc.

The resulting biopsy specimen is smeared on glass, and then microscopic examination is carried out.

Although cytological diagnosis is considered easier and faster, histology is still more reliable and accurate.

Training

Before a biopsy, the patient must undergo a laboratory study of blood and urine for the presence of various infections and inflammatory processes. In addition, magnetic resonance, ultrasound, X-ray diagnostics are carried out.

The doctor examines the picture of the disease and finds out whether the patient is taking medication.

It is very important to tell the doctor about the presence of pathologies of the blood coagulation system and allergies to drugs. If the procedure is planned to be carried out under anesthesia, then you can not eat and drink liquid for 8 hours before the biopsy is taken.

How is a biopsy done in certain organs and tissues?

Biomaterial sampling is carried out using general or local anesthesia, so the procedure is usually not accompanied by painful sensations.

The patient is placed on the couch or operating table in the position required by the specialist. Then proceed to the process of obtaining a biopsy. The total duration of the process is often several minutes, and with invasive methods it can be up to half an hour.

In gynecology

An indication for a biopsy in gynecological practice is the diagnosis of pathologies, and the vagina, ovaries, external organs of the reproductive system.

Such a diagnostic technique is decisive in the detection of precancerous, background and malignant formations.

Used in gynecology:

• Incisional biopsy - when scalpel excision of tissue is performed;
• Targeted biopsy - when all manipulations are controlled by extended hysteroscopy or colposcopy;
• Aspiration - when the biomaterial is obtained by aspiration;
• Laparoscopic biopsy - in this way, a biopsy is usually taken from the ovaries.

An endometrial biopsy is performed by means of a pipel biopsy, in which a special curette is used.

Intestines

A biopsy of the small and large intestines is performed in various ways:

• Puncture;
• Petlev;
• Trepanation - when the biopsy is taken using a sharp hollow tube;
• Shchipkov;
• incisional;
• Scarifying - when a biopsy is scraped off.

The specific choice of method is determined by the nature and location of the area under study, but most often they resort to colonoscopy with biopsy.

Pancreas

Biopsy material from the pancreas is obtained in several ways: fine-needle aspiration, laparoscopic, transduodenal, intraoperative, etc.

Indications for pancreatic biopsy is the need to determine the morphological changes in pancreatic cells in the presence and to identify other pathological processes.

muscles

If a doctor suspects that a patient has developed systemic connective tissue pathologies, which are usually accompanied by muscle damage, a biopsy of the muscle and muscle fascia will help determine the disease.

In addition, this procedure is carried out in case of suspicion of the development of periarteritis nodosa, dermatopolymyositis, eosinophilic ascites, etc. Such a diagnosis is used with needles or in an open way.

Heart

Biopsy diagnostics of the myocardium helps to detect and confirm such pathologies as myocarditis, cardiomyopathy, ventricular arrhythmia of unknown etiology, as well as to identify the processes of rejection of the transplanted organ.

According to statistics, right ventricular biopsy is more often performed, while access to the organ is carried out through the jugular vein on the right, femoral or subclavian vein. All manipulations are controlled by fluoroscopy and ECG.

A catheter (biopt) is inserted into the vein, which is brought to the required site where the sample is to be obtained. On the bioptom, special tweezers are opened, which bite off a small piece of tissue. During the procedure, a special medication is given through the catheter to prevent thrombosis.

Bladder

Bladder biopsy in men and women is performed in two ways: cold and TUR biopsy.

The cold method involves transurethral cytoscopic penetration and biopsy sampling with special tweezers. A TUR biopsy involves removing the entire tumor down to healthy tissue. The purpose of such a biopsy is to remove all visible formations from the bladder walls and make an accurate diagnosis.

Blood

A biopsy of the bone marrow is performed in the case of malignant tumor pathologies of the blood like.

Also, a biopsy study of bone marrow tissue is indicated for iron deficiency, splenomegaly, thrombocytopenia and anemia.

With a needle, the doctor takes a certain amount of red bone marrow and a small bone sample. Sometimes the study is limited to obtaining only a bone tissue sample. The procedure is performed by aspiration method or trepanobiopsy.

Eyes

Examination of the tissues of the eye is necessary, in the presence of a tumor formation of a malignant origin. These tumors are common in children.

A biopsy helps to get a complete picture of the pathology and determine the extent of the tumor process. In the process of diagnosing retinoblastoma, an aspiration biopsy technique using vacuum extraction is used.

Bone

A bone biopsy is performed to detect either infectious processes. Usually, such manipulations are carried out percutaneously by puncture, with a thick or thin needle, or surgically.

Oral cavity

Biopsy examination of the oral cavity involves obtaining a biopsy from the larynx, tonsils, salivary glands, throat and gums. Such a diagnosis is prescribed when pathological formations of the jaw bones are detected, or, to determine salivary glandular pathologies, etc.

The procedure is usually performed by a facial surgeon. With a scalpel, he takes a part and the whole tumor. The whole procedure takes about a quarter of an hour. Soreness is observed when an anesthetic is injected, and there is no pain when taking a biopsy.

Analysis results

The results of biopsy diagnostics are considered normal if the patient does not show any cellular changes in the examined tissues.

Effects

The most common consequence of such a diagnosis is rapidly passing bleeding and soreness at the site of the biopsy.

Moderately weak pain is experienced by about a third of patients after a biopsy.

Serious complications after a biopsy usually do not occur, although in rare cases, fatal consequences of a biopsy occur (1 in 10,000 cases).

Care after the procedure

With severe pain syndrome, analgesics can be used. Care of the puncture site or suture (depending on the type of procedure) may vary somewhat, but the bandage can be removed only a day after the biopsy, then you can take a shower.

All materials on the site are prepared by specialists in the field of surgery, anatomy and related disciplines.
All recommendations are indicative and are not applicable without consulting the attending physician.

An intestinal biopsy is one of the most informative ways to find out what changes occur in its mucosa. Histological examination allows not only to make an accurate diagnosis, but also to determine the subsequent treatment tactics.

Intestinal pathology can be diagnosed in both adults and children, and often symptoms and laboratory data are not enough. In such cases, a biopsy comes to the rescue - a histological analysis of the mucosa of the small or large intestine. Tissue for research is obtained by endoscopy of the intestine.

The widespread use of intestinal biopsy as a valuable diagnostic method was made possible not only by the invention of the microscope. For a long time, only superficially located tissues could be subjected to microscopy, and internal organs were examined only during open operations. The introduction of endoscopic techniques, the improvement of methods of minimally invasive interventions made it possible to make non-surgical intestinal biopsy a screening event available to a wide range of patients.

In the case when mucosal microscopy does not give a complete answer to the questions of interest, pathologists conduct an additional immunohistochemical study of the tissue sample, including the determination of proteins specific for a given disease or type of malignant tumor in the intestinal cells.

Colonoscopy or fibrogastroduodenoscopy with biopsy is performed if indicated, as well as during routine preventive examinations. The risk group includes people of both sexes, starting from the age of 40. The older the subject, the more likely it is that the biopsy will show at least some deviation. The procedure is prescribed by therapists, gastroenterologists, proctologists.

Taking an intestinal biopsy is not the most pleasant event, however, it is possible to reduce not only the likelihood of complications, but also minimize subjective discomfort by properly preparing both physically and psychologically.

Indications and contraindications for intestinal biopsy

A bowel biopsy is performed with an unclear diagnosis, ineffectiveness of the prescribed treatment, to clarify the results of therapy, if cancer is suspected. Testimony to it are considered:

• Changes in blood and stool tests, indicating the presence of an ulcer;
• Suspicion of the infectious nature of the intestinal lesion;
• Autoimmune diseases with possible damage to the digestive system;
• anemia, unexplained weight loss;
• Untreated prolonged constipation;
• The presence of protrusions (diverticula) of a congenital or acquired nature;
• Suspicion of a malignant tumor;
• Chronic nonspecific inflammatory processes;
• Systemic amyloidosis;
• rectal fistulas;
• Nonspecific ulcerative colitis and Crohn's disease;
• Polyps and other hyperplastic processes in the intestine;
• celiac disease;
• Narrowing (stenosis).

An intestinal biopsy is performed not only in the presence or suspicion of a pathological process. It is also shown to people of mature and old age, who do not present any complaints from the digestive system, as part of annual preventive examinations.

Given the increasing incidence of malignant tumors of the colon, prophylactic colonoscopy with biopsy is considered a necessary measure for the early detection of colon cancer. It is clear that the procedure is not pleasant, but even if there are no symptoms of disorders, it is still better to make sure that the intestines are healthy.

An intestinal biopsy requires good preparation and a satisfactory condition of the patient, otherwise the procedure may lead to complications, so specialists always find out possible contraindications, which can be:

1. Surgical intervention on the digestive organs transferred in the recent past;
2. Acute infectious diseases or exacerbation of chronic ones;
3. Acute inflammatory process, diverticulitis due to the risk of perforation;
4. Peritonitis;
5. Rough stenoses of the intestine, which will be difficult to “pass through” with an endoscope without the risk of injury to the organ wall;
6. Severe cardiac, renal, hepatic, respiratory failure;
7. Separate mental illnesses in which there is no contact with the patient or there is no confidence in his adequate attitude to the procedure.

An intestinal biopsy is always stressful for the subject, who can worry both about the course of the procedure and the result of the histological analysis. However, if the doctor considers the procedure necessary, it is unacceptable to refuse it, because the disease without timely therapy can progress, give complications, and even transform into cancer.

Study preparation

The safety and the highest information content of colonoscopy with intestinal biopsy can only be guaranteed with high-quality preparation. It is important that the examined organ be as clean as possible, and the care of this lies with the patient himself, who must approach the issue of preparation very responsibly.

Before a colonoscopy, you will:

• Carry out cleansing enemas;
• Prepare the intestines with the help of special preparations (fortrans, forject);
• Follow the diet for a week before the study.

Diet - the first measure for high-quality bowel preparation. The subject will need to exclude from the diet products that cause constipation and gas formation - confectionery and bakery products, chocolate, legumes, fresh vegetables and fruits, carbonated drinks, coffee. It is better to give up spicy, fried foods, smoked meats that irritate the mucous membrane. Food should be light and accessible, preferably steamed or stewed.

A day before the scheduled procedure, special preparations are prescribed that help remove contents and gases from the intestines. They are sold in a regular pharmacy, they are bags of powder that dissolves in water and is drunk in accordance with the instructions. During the day, the patient will have to drink several liters of such a solution, but the usual meals will have to be abandoned. To reduce gas formation, espumizan or its analogues are additionally prescribed. It is desirable that by the time of endoscopic examination the intestine was empty.

If the preparation is carried out with cleansing preparations, there is no need to use enemas, which are uncomfortable for most patients. However, enemas are still used if other methods are not available for any reason.

The most common and effective drug for cleansing the intestines is considered fortrans. Experts say that even a single use of the effect is equal to a triple enema. It is especially important that such cleansing can be done independently and at home.

The amount of fortrans is calculated based on the weight of the subject, with a liter of the drug per 20 kilos of weight. You should drink it every 20 minutes, about a glass. You should not rush, otherwise vomiting and abdominal pain may occur. The first appointment should be no later than 18 hours before the study, the last - 3 hours.

A biopsy of the small intestine is performed with fibrogastroduodenoscopy, so the preparation will be somewhat different: a diet the day before, a ban on eating on the day of the study, sedatives. The small intestine has a large length, a relatively narrow lumen, it is tortuous, so only its initial part, the duodenum, can be examined with an endoscope. Further advancement of the instrumentation is considered dangerous.

Intestinal Biopsy Technique

As a rule, a biopsy of the intestine is diagnostic. In other words, the endoscopist examines the surface of the mucosa, makes a conclusion regarding the presence and nature of the pathology, and takes those parts of the intestinal wall that are most changed or cause any concern.

If during the procedure a complete excision of the pathological focus (polyp, a small benign tumor) is performed, then the biopsy will become not only a diagnostic stage, but also a very effective treatment procedure that eliminates the pathology in a minimally invasive way.

There are many ways to take material for histological examination. This may be excision of a mucosal site or a detected neoplasm with a scalpel, loop, needle aspiration, etc., but endoscopic forceps biopsy, during which the tissue is plucked off with special forceps, is considered the best method.

Biopsy of the small intestine most often limited to a morphological study of the duodenal mucosa, since the underlying sections are difficult to inspect and, moreover, pinch off the tissue. Such a biopsy is carried out during fibrogastroduodenoscopy.

bowel biopsy technique

An endoscope with a light guide is inserted through the mouth and esophagus into the stomach, from where it descends into the duodenum. During the study, discomfort associated with the introduction of the probe is possible: salivation, retching, gas discharge from the intestines, and even involuntary urination.

The doctor warns the subject in advance about the likely subjective discomfort, talks about the course of the procedure. Approximately 30 minutes before fibrogastroduodenoscopy, it is advisable to take a sedative to relieve tension and anxiety. The patient during a biopsy of the small intestine should be conscious.

To somewhat reduce vomiting, the back wall of the pharynx is treated with an anesthetic, a special mouthpiece is placed in the oral cavity so that the patient does not accidentally damage the endoscopic tube with his teeth.

During duodenoscopy with duodenal biopsy the subject lies on the left side, the endoscope is inserted through the oral cavity. The doctor records all changes in the mucous membrane on the monitor screen. Forceps for tissue sampling for histological analysis are inserted through a special channel in the endoscopic tube. A biopsy is taken aimingly if the pathology is localized.

The resulting tissue fragment is placed in a vial with a formalin solution, and then sent to the histopathological laboratory for the manufacture of a micropreparation, which will be studied under a microscope. After removing the tissue, the endoscopist once again checks for bleeding vessels, then removes the instruments.

The duodenoscopy procedure with biopsy of the small intestine lasts about half an hour. As a rule, it does not cause pain. Much worse for many subjects is not possible pain, but subjective discomfort due to vomiting, belching, etc.

colon polyp biopsy

Colon biopsy is carried out during colonoscopy or sigmoidoscopy after careful preparation of the intestine and only with the written consent of the subject. The doctor necessarily explains the features of the research methodology, possible complications, the role of adequate bowel preparation.

During endoscopic examination of the large intestine with a biopsy, the patient is placed on the left side, while he must bring the lower limbs to the anterior abdominal wall. Before the procedure, the level of blood pressure, pulse is necessarily determined.

The final sections of the intestine are the first to be examined. During sigmoidoscopy, an examination is performed with a biopsy of the rectum, then the sigmoid section is examined. Fibrocolonoscopy allows assessing the condition of the colon, while it is advisable to conduct a preliminary x-ray examination with contrast to exclude the presence of pronounced stenosis and other obstacles to the movement of the endoscope.

Many patients undergoing endoscopy with colon biopsy wish to have it done under general intravenous anesthesia. This question should be discussed in advance with the attending physician, since it will also be necessary to prepare for anesthesia.

The end section of the colonoscope is inserted into the rectum and then into the large intestine, pre-lubricated with Vaseline to facilitate passage through the rectal sphincter to make this moment painless. The collapsed loops of the empty intestine are straightened out by the air introduced there to facilitate the examination of the mucous membrane.

The large intestine has curves, and they must be taken into account by the doctor conducting the study. At the moment when the endoscope reaches the sigmoid colon, the patient is turned on his back, continuing the introduction of instruments. As the examination progresses, the doctor notices local or diffuse changes, makes a biopsy from pathological foci, and can completely excise a tumor-like submucosal formation, a polypoid outgrowth of the mucous membrane.

Upon completion of the study of the intestinal wall, the specialist makes sure that there is no bleeding and takes the endoscopic instruments out. The taken material is sent to the laboratory for histopathological examination. The answer will be ready in about 10-14 days.

In pediatric practice, there is also a need for a biopsy of the intestinal wall. Indications for it may be some congenital malformations, suspicion of Crohn's and Hirschsprung's disease. For research, a children's endoscope is taken, sedation is mandatory, and children of the first years are given general anesthesia for 30-40 minutes, during which the doctor examines the intestines and takes a biopsy if necessary.

Video: rectal biopsy

Intestinal Biopsy Findings and Possible Complications

Before an endoscopic examination of the gastrointestinal tract with a biopsy, the patient must give his written consent to the manipulation, and the doctor must explain not only its meaning and purpose, but also talk about possible complications. The risk of adverse effects depends on the nature of the pathology, the quality of bowel preparation, the skills and qualifications of the specialist.

The most frequent complications bowel biopsies consider bleeding and perforation. In the first case, it is enough to coagulate the damaged vessels, in the second, a surgical operation is indicated to restore the integrity of the intestine. If an injury to the organ wall caused its rupture and peritonitis, then the patient is urgently taken to the operating room, where the defect is immediately sutured.

A rupture of the intestine can provoke not only the rough introduction of instruments, but also gases that were not removed during the preparation stage. Coagulation of vessels or excision of a neoplasm with an electrocoagulator can lead to an explosion of gases and serious injury to the intestinal wall, which can be avoided by properly preparing for the study.

The results of the biopsy are usually ready after 7-10 days, maximum - 2 weeks. The study of the microscopic structure of intestinal tissues is carried out by pathologists who convey conclusions about the nature of the pathology to endoscopists, gastroenterologists, proctologists, who decide what treatment the patient needs. The attending physician should interpret the conclusion of the histological analysis; it is highly not recommended to do this on your own in order to avoid erroneous judgments and premature anxiety.

In the conclusion of the pathologist, there may be indications of:

1. Chronic colitis requiring diet and conservative therapy;
2. Adenomas are benign tumors;
3. The presence of ulcerative lesions of the duodenum 12;
4. Crohn's disease, ulcerative colitis, celiac disease;
5. Malignant tumor.

A biopsy of a polyp of the rectum or overlying parts most often shows that the glandular outgrowth is a benign tumor, which, nevertheless, may have signs of dysplasia, that is, a precancerous process. There is no need to panic at this conclusion, because usually polyps are completely removed during a biopsy.

Dysplastic processes and adenomas do not require further surgery or other antitumor therapy, however, they require annual monitoring of the state of the intestine, the owner of which should be under the close attention of doctors. If the intestinal biopsy shows the presence of adenocarcinoma, that is, a malignant tumor, the patient is referred to an oncologist to decide whether to remove the tumor and conduct chemotherapy and radiation therapy.

Most of us associate the term "biopsy" with oncology, and therefore, when a doctor prescribes such a study, a person experiences quite understandable excitement. In order not to torment yourself with vague anxieties and fears, you need to understand what this procedure is in general.

Leading clinics abroad

What is a biopsy and what does it show?

Imagine this picture: the therapist tells the patient that in order to make a diagnosis, he needs to donate blood. Such a doctor's appointment does not cause any negative emotions, because since childhood we have had to periodically - from a vein or from a finger. So, a biopsy is a similar procedure, during which a tiny part of an organ is taken for certain tests. There is nothing wrong with her.

The sampling of biomaterial is carried out from the site of the organism that causes suspicion. This may be a tumor formation, induration, a wound that does not heal for a long time, etc. The biological material removed for analysis is subjected to histological or cytological examination.

Histological examination. During it, the tissue itself is analyzed. It is dehydrated, treated with paraffin and cut with a microtome (a special knife) into the thinnest plates an order of magnitude thinner than a millimeter. After staining with special dyes, the plates are carefully examined under a microscope. Malignant cells differ from healthy ones in structure and size, and they also absorb dyes more strongly.

Cytological examination. It is carried out if there is no need for tissue analysis, for example, when a fistula fester. Here, the fluid secreted from the fistulous passage is taken for analysis, studied under a microscope, and the bacterial nature is determined. Based on the results, the doctor prescribes antibiotic therapy. But the reliability of a cytological study is still somewhat lower than a histological one.

Biopsy allows to detect pathology at the earliest stage and get accurate information about the disease . Especially successfully about It is not used in gynecology and gastroenterology. Often it is carried out for the diagnosis of various non-tumor diseases.

Who needs a bowel biopsy?

An intestinal biopsy (BC) is prescribed in cases where the following pathologies are present:

• prolonged bowel dysfunction (bloating, chronic constipation);
• suspicion of polyps and tumor neoplasms;
• narrowing of the intestinal lumen (found on x-ray);
• the presence of blood or mucus in the feces;
• ulcerative colitis (chronic);
• Crohn's syndrome (autoimmune inflammation of the intestinal wall);
• the presence of rectal fistulas;
• abnormal development of the intestine.

The removal of tissues for analysis is carried out only in the process of colonoscopy - probe endoscopic examination. It is during this procedure that the doctor, noticing the pathology, decides on the need for a biopsy.

Contraindications for carrying out

BC cannot be carried out in the following cases:

• in the presence of a severe infection;
• after a recent operation;
• with severe inflammatory gynecological diseases;
• in case of critical narrowing of the intestinal lumen;
• in severe forms of heart (pulmonary) insufficiency;
• with inflammation of the peritoneum, etc.

Leading specialists of clinics abroad

How to prepare for the BC?

The better the intestines are cleaned, the more accurate the result will be. Therefore, the patient must prepare for the study. To cleanse the body, perform the following steps:

• within 7 days before the colonoscopy, they eat only light, easily digested food;
• drink plenty of water for 2-3 days before the examination;
• do not eat anything during the day before the procedure, only drink water;
• cleansing enemas are done before the procedure;
• cleanse the body with medications (for example, Fortrans).

How is an intestinal biopsy performed?

This procedure can cause a lot of negative emotions in the patient. He is afraid of pain and at the same time is embarrassed by everything that happens. Anesthesia helps to relieve the patient's negative feelings:

• local, when the doctor lubricates the tip of the colonoscope with an anesthetic;
• general, when a person is sleeping and does not feel what is happening;
• sedation, when the patient is administered tranquilizers, and he loses his fear of pain, plunging into a superficial sleep.

To date, two methods of aspiration biopsy of the intestine are used:

1. Sighting. This modern method allows for a minimally invasive intervention and obtaining material for research from almost any part of the small intestine. For the procedure, the doctor needs an endoscope (anoscope) and special rectal biopsy forceps, which have a spike (needle) at the end and cups with jagged edges. The spike helps to fix the forceps, and the pointed edges of the cups make an accurate grip of the tissues and cut them off.
2. blind. Although this technique is considered somewhat outdated and traumatic, in some cases the doctor has to use it. Here, a Rubin probe is used to take biomaterial from the required anatomical region. The material from which it is made is radiopaque, and the intervention is carried out under X-ray control. Unlike the previous method, this type of study, although inconvenient, has one undoubted advantage - tissue sampling occurs from each layer of the intestinal mucosa.

Intestinal biopsy- a procedure that must be performed very carefully so as not to damage the pathological areas, the walls of the intestine and not cause bleeding.

BC - does it hurt?

The sensations of patients directly depend on the type of anesthesia. In general, a person sleeps and does not feel anything. With the local one, he experiences not very pleasant, but quite tolerable sensations: he feels how the endoscope moves, feels bloating. If sedation was used, the patient may subsequently have jerky memories of what is happening, he does not experience any pain.

Possible consequences and safety of the procedure

Violation of the stool is one of the consequences of CD. A person may suffer from diarrhea or constipation for several days. If there are violations of bowel movements, this should be reported to the doctor immediately. Deviations from the norm in these cases can be signals of serious health problems.

Recovery after BC

After the procedure, the intestines need to recover. You can not load the digestive system immediately after a colonoscopy. Recovery usually takes several days, during which time the diet should be followed. It is prescribed by a doctor, taking into account the patient's illness and his well-being. It is possible that during the procedure the intestinal mucosa will be injured, so the diet should be sparing.

It is advisable to prefer liquid meals, do not eat fatty and spicy foods. Food should be easily absorbed by the gastrointestinal tract, and the amount eaten at one time should be small. The main goal of the rehabilitation period after CD is the restoration of the mucosal microflora. For this, it is recommended to take probiotics and eat dairy products.

Prices

Finding out the cost of CD without the cost of colonoscopy is meaningless, because the first study cannot be carried out without the second. In Moscow, you will have to pay at least 1,500 rubles for a biopsy, and 4,500 rubles for a colonoscopy. and more. In Kyiv, a biopsy costs from 80 UAH, a colonoscopy - from 990 UAH. As a rule, in the price lists of clinics, prices are indicated without taking into account the cost of anesthesia, since local and general anesthesia differ in price.

conclusions

Deciphering the results of the study allows not only to find out if the patient has a cancerous tumor, but also to determine the likelihood of its development. How? Modern scientists believe that cancer does not develop in healthy organs, does not affect healthy tissues, and that each cancer is first preceded by a disease called precancerous in medicine. They argue that the process of transformation of healthy cells into malignant ones does not occur instantly, and it can be diagnosed using various morphological methods, including biopsy.

Allows doctors to detect people at risk of cancer, monitor them regularly and start anti-cancer treatment on time. According to world standards, colonoscopy and CD should be done periodically for all people over 45 years old, since bowel cancer in most cases affects people of this age. Perhaps someday we will all understand that it is necessary to start fighting cancer even when it is not there, by conducting the necessary studies of the tissues of problematic organs in time.