surgical ppt

1. Wednesday,
April 12, 2023
1
GIT Endoscopic biopsy
DR. HIWA OMER AHMED
PROFESSOR IN GENERAL AND BARIATRIC SURGERY
UNIVERSITY OF SULAIMANI
COLLEGE OF MEDICINE – SULAIMANI CITY- KURDISTAN

2. Wednesday,
April 12, 2023
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endoscopy
 Since fiberscope was introduced in 1958, gastroscopy
and colonoscopy have made large contributions in the
diagnosis of gastrointestinal disease; additionally, the
development of the video endoscope provided
further diagnostic improvement

3. Wednesday,
April 12, 2023
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Biopsies
 During endoscopy, multiple biopsies are often
necessary to diagnose cancer at the potential malignant
lesion site in the stomach or colon as a standard
diagnostic tool for pathologic confirmation.
 Twenty to thirty years ago, the number of endoscopic
biopsy specimens needed to diagnose gastric or colon
cancer during fiberoptic endoscopy varied from 4 to 10.

4. Wednesday,
April 12, 2023
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Number of biopsies
 Currently, 6 to 8 biopsies are recommended for
diagnosis of a suspected malignant lesion
 However, the increase in the number of biopsies
performed may cause an increased risk of
complications, such as
1. Gastrointestinal bleeding.
2. Procedure prolongation
3. Increased workload to pathologists.

5. Wednesday,
April 12, 2023
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Dx versus biopsy numbers
 Positive diagnosis rates of
the first, second, and third
advanced gastric cancer
specimens were 81.3%,
94.9%, and 98.3%,
respectively, while positive
diagnosis rates of advanced
colon cancer specimens
were 78.1%, 87.5%, and
93.8%. Further biopsies
did not increase positive
diagnosis cumulative
rates.

6. Wednesday,
April 12, 2023
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Each biopsy specimen must
1. Immediately immersed (fixed) in 20% formalin solution in separate vials
2. Each bottle must took a code number to identify the serial order.
3. Location
4. Size
5. Shape
6. Macroscopic classifications of the lesion suspected of malignancy
7. Patient's age, sex
8. Principal symptoms
9. Indications for diagnostic endoscopy

7. Wednesday,
April 12, 2023
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Accuracy depends on
1. Number 3-4
2. Biopsy site
From the rim of an ulcer showed more accurate diagnostic results
compared to those taken from ulcer base
3. Experienced endoscopists:
can differentiate malignant lesions from benign lesions by examination of
its gross appearance and need not take excessive number of biopsies.
4. Gastrointestinal pathology
5. In cases of negative results with the endoscopic impression of malignancy,
re-biopsy with careful targeting should be performed.

8. Wednesday,
April 12, 2023
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Macroscopic appearance of gastric
cancer

9. Wednesday,
April 12, 2023
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Macroscopical staging

10. Wednesday,
April 12, 2023
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Biopsy site

11. Wednesday,
April 12, 2023
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Covering mucosa