1123 An Audit of Pick-Up Rate of Random Colonic Biopsies

Aim We aimed to evaluate optimal random biopsy criteria are being followed in our institution to increase the diagnostic yield of a subsequent histopathological examination and to reduce the number of unnecessary biopsies in which histopathology is unlikely to deliver clinically useful information and causing a burden on health resources in terms of cost and manpower. Method Our study was a retrospective on 419 random colonoscopy biopsies performed over 6 months. Data collection included variables such as age, gender, indications, request of urgency, and histology findings. Data analysis was done descriptively. Results Out of 419 random biopsies, only 10.02% had positive findings. The total number of histology results with microscopic colitis was 10. The main indication of the random colonic biopsy was a change in bowel habits (328 cases) followed by significant diarrhea greater than 50 years in 20 cases. In patients with a change in bowel habits, 2.44% of histopathology specimens revealed microscopic colitis. The percentage of random colonic biopsy histology in patients greater than 50 years with significant diarrhea showed microscopic colitis was 10%. Conclusions Our study revealed random biopsy during colonoscopy should only be done in selected patients otherwise it has low diagnostic yields biopsy and should only be reserved for patients with risk factors for optimum utilization of health resources and to reduce the cost burden. A scoring system may be helpful to risk-stratify patients in low and high risk for MC to determine which patients qualify for RCB.

Case Report: Two Infant Cases of Langerhans Cell Histiocytosis Involving the Digestive Tract

Langerhans cell histiocytosis (LCH) is a rare disease with uncertain etiology. Langerhans cell histiocytosis with involvement of the gastrointestinal tract is rare and is typically identified in pediatric patients with systemic disease. The present study reports two infantile cases of LCH who initially presented with diarrhea, hematochezia, and rash and were histologically missed on the original examination of the colonic biopsy sections. The diagnosis of LCH was later verified through immunohistochemistry. By combining our experience and previous reports, the multiple hemorrhagic spots of the colorectal mucosa and narrowness and erosion of the distal duodenum might be suggestive manifestations of gastrointestinal involvement in LCH on endoscopic examination. This might be helpful for the early recognition of the disease.

Development of Mucosal PNAd+ and MAdCAM-1+ Venules during Disease Course in Ulcerative Colitis

PNAd and MAdCAM-1 addressins on venules are of importance in T-cell homing and potential therapeutic targets in ulcerative colitis (UC). Normally, PNAd+ high endothelial venules (HEVs) are only present in lymphoid organs, whereas small numbers of MAdCAM-1+ venules can be seen in non-lymphoid tissue. We aimed to study their presence in the intestinal mucosa of UC patients at diagnosis and during follow-up, and their correlation with disease activity. Colonic biopsy specimens of 378 UC patients were analyzed by immunohistochemistry for CD3, CD20, ERG, MECA-79 (PNAd) and MECA-376 (MAdCAM-1) and compared to healthy controls (HC). The proportion of PNAd+HEVs in UC at diagnosis was 4.9% (IQR 2.0%–8.3%), while none were detected in HC. During follow-up, PNAd+HEVs completely disappeared in remission (n = 93), whereas the proportion in active disease was similar to baseline (n = 285, p = 0.39). The proportion of MAdCAM-1+venules in UC at baseline was 5.8% (IQR 2.6–10.0). During follow-up, the proportion in remission was comparable to diagnosis, but upregulated (7.5% (IQR 4.4–10.9), p = 0.001) in active disease. In conclusion, PNAd+HEVs appear in UC during active inflammation which could thus serve as a marker for disease activity, whereas MAdCAM-1+venules remain present after inflammation is resolved and increase after subsequent flares, reflecting chronicity and potentially serving as a therapeutic target.

Colonoscopy to diagnose chronic ulcerative colitis in an 11-years-old Maltese

An 11-year-old castrated male Maltese was examined for increased frequency of defecation, mucus in feces, and chronic diarrhea with hematochezia. The dog was referred to Veterinary Teaching Hospital, Faculty of Veterinary Medicine, IPB University for further evaluation. Ultrasonography and colonoscopy were performed to further diagnose. Abdominal ultrasonography was taken using a linear probe with frequency 6-11 MHz. Colonoscopy was performed using colonoscope with tube length 700 mm and diameters 10 mm under anesthesia. Abdominal ultrasonography showed that the dog had a mucocele gall bladder, cholecystitis, hepatitis, slight-mild splenitis, nephrolithiasis, urolithiasis and thickened of the duodenal wall due to inflammatory bowel diseases. Colonoscopy showed ulceration and hemorrhage along the surface of the colon, whereas hyperemia only seen on the ascending colon. Based on endoscopic examination, the dog was diagnosed with severe and chronic ulcerative colitis. The authors recommended that the colonic biopsy should be undertaken in the dog presented with chronic ulcerative colitis.

Morphologic Clues Identify Muscularis Propria at Colonic Biopsy and Warn of Potential Perforation

Objectives Perforation is currently believed to be a rare but potentially serious complication of colonic biopsies performed with cold forceps. Most reported cases have occurred in the setting of colitis. The presence of muscularis propria in specimens from colonic biopsies might portend increased risk of perforation. However, identifying muscularis propria at time of biopsy is difficult for many reasons, including histologic overlap with muscularis mucosa. Incidental muscularis propria obtained in this manner has yet to be studied. We hypothesized that differences in nuclear density could distinguish muscularis propria from muscularis mucosa. Methods We retrospectively reviewed 3 specimens from colonic biopsies performed with cold forceps for which muscularis propria was presumed to be visualized based on the presence of smooth muscle with lower nuclear density compared to areas known to be muscularis mucosa. All patients were adults clinically suspected to have colitis. These specimens were then compared to a full-thickness section from normal colonic tissue obtained via colectomy that served as control to confirm whether nuclear density or other features could distinguish muscularis propria from muscularis mucosa. Results Muscularis propria in the control tissue had lower nuclear density, more cytoplasmic pallor, greater maximal thickness, and smoother texture than the corresponding muscularis mucosa in the control tissue. The constellation of these features was consistently seen in all three specimens obtained via biopsy and therefore confirmed the presence of muscularis propria in all three specimens, although all patients lacked perforation clinically. Surprisingly, all three specimens had histologically normal mucosa. Conclusion We showed that several morphologic features, including low nuclear density, identify muscularis propria at time of colonic biopsy and alert endoscopists to the possibility of perforation, and we showed that muscularis propria can accompany normal mucosa obtained via biopsy with cold forceps. Additional studies are necessary to further validate these findings.