Endoscopic tissue sampling - Part 2: Lower gastrointestinal tract. European Society of Gastrointestinal Endoscopy (ESGE) Guideline.

1: ESGE suggests performing segmental biopsies (at least two from each segment), which should be placed in different specimen containers (ileum, cecum, ascending, transverse, descending, and sigmoid colon, and rectum) in patients with clinical and endoscopic signs of colitis.Weak recommendation, low quality of evidence. 2: ESGE recommends taking two biopsies from the right hemicolon (ascending and transverse colon) and, in a separate container, two biopsies from the left hemicolon (descending and sigmoid colon) when microscopic colitis is suspected.Strong recommendation, low quality of evidence. 3: ESGE recommends pancolonic dye-based chromoendoscopy or virtual chromoendoscopy with targeted biopsies of any visible lesions during surveillance endoscopy in patients with inflammatory bowel disease. Strong recommendation, moderate quality of evidence. 4: ESGE suggests that, in high risk patients with a history of colonic neoplasia, tubular-appearing colon, strictures, ongoing therapy-refractory inflammation, or primary sclerosing cholangitis, chromoendoscopy with targeted biopsies can be combined with four-quadrant non-targeted biopsies every 10 cm along the colon. Weak recommendation, low quality of evidence. 5: ESGE recommends that, if pouch surveillance for dysplasia is performed, visible abnormalities should be biopsied, with at least two biopsies systematically taken from each of the afferent ileal loop, the efferent blind loop, the pouch, and the anorectal cuff.Strong recommendation, low quality of evidence. 6: ESGE recommends that, in patients with known ulcerative colitis and endoscopic signs of inflammation, at least two biopsies be obtained from the worst affected areas for the assessment of activity or the presence of cytomegalovirus; for those with no evident endoscopic signs of inflammation, advanced imaging technologies may be useful in identifying areas for targeted biopsies to assess histologic remission if this would have therapeutic consequences. Strong recommendation, low quality of evidence. 7: ESGE suggests not biopsying endoscopically visible inflammation or normal-appearing mucosa to assess disease activity in known Crohn's disease.Weak recommendation, low quality of evidence. 8: ESGE recommends that adequately assessed colorectal polyps that are judged to be premalignant should be fully excised rather than biopsied.Strong recommendation, low quality of evidence. 9: ESGE recommends that, where endoscopically feasible, potentially malignant colorectal polyps should be excised en bloc rather than being biopsied. If the endoscopist cannot confidently perform en bloc excision at that time, careful representative images (rather than biopsies) should be taken of the potential focus of cancer, and the patient should be rescheduled or referred to an expert center.Strong recommendation, low quality of evidence. 10: ESGE recommends that, in malignant lesions not amenable to endoscopic excision owing to deep invasion, six carefully targeted biopsies should be taken from the potential focus of cancer.Strong recommendation, low quality of evidence.

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Déclaration de conflit d'intérêts

M. Barret has received consultancy fees from Medtronic (2018 to present) and Pentax (2019 to present). R. Bisschops has received consultancy and speaker’s fees from Fujifilm, Pentax, Medtronic (all 2015 to present), and Norgine (2016 to present), consultancy fees from Boston Scientific, Cook (both 2015 to present), CDx Diagnostics (2017 to present), and GI Supply (2018 to present), and speaker’s fees from Medivators (2017 to 2018) and Ipsen (2020 to present); his department has received research grants from Fujifilm, Pentax (both 2015 to present), Cook (2016 to 2019), and Medtronic (2018 to present). M. Dinis Ribeiro is co-editor-in-chief of Endoscopy; his department has received a research grant from Fujifilm (2020 to present) and an educational grant from Olympus (2020 to present). M. Iacucci has received research grant support from Pentax (2016 to present), Olympus (2018 to 2020), and Fujifilm (2019 to present). M.C.W. Spaander has received research support from Boston Scientific (2013 to present) and Cook Medical (2009 to 2013). J.E. van Hooft has received lecture fees from Medtronic (2014, 2015, and 2019) and Cook Medical (2019), and consultancy fees from Boston Scientific (2014 to 2017) and Olympus (2021); her department has received research grants from Abbot (2014 to 2017) and Cook Medical (2014 to 2019). K. Biermann, L. Czakó, K.B. Gecse, G. de Hertogh, T. Hucl, M. Jansen, R.E. Pouw, M. Rutter, E. Savarino, P.T. Schmidt, and M. Vieth declare that they have no conflict of interest.