Intestinal Biopsy in Pediatric Medicine
Intestinal biopsy is a crucial diagnostic procedure in pediatric gastroenterology that involves obtaining small samples of intestinal tissue for histological examination.
Key Points:
- Gold standard for diagnosis of various intestinal pathologies
- Can be performed endoscopically or through capsule biopsy
- Essential for diagnosing celiac disease, inflammatory bowel disease, and other enteropathies
- Requires specific preparation and handling protocols
Primary Clinical Indications
- Suspected celiac disease
- Chronic diarrhea
- Failure to thrive
- Malabsorption syndromes
- Inflammatory bowel disease evaluation
- Persistent iron deficiency anemia
- Food allergies with gastrointestinal manifestations
- Protein-losing enteropathy
Diagnostic Goals
- Assessment of villous architecture
- Evaluation of inflammatory changes
- Detection of specific cellular infiltrates
- Identification of infectious organisms
- Assessment of brush border enzyme expression
Procedure Techniques
Endoscopic Biopsy
- Most common method currently used
- Requires general anesthesia in children
- Allows direct visualization of mucosa
- Multiple biopsies can be obtained
- Typical sites: duodenum, terminal ileum, varying colonic locations
Pre-procedure Preparation
- Fasting requirements:
- Clear liquids: 2 hours before procedure
- Breast milk: 4 hours before procedure
- Formula/solid food: 6 hours before procedure
- Laboratory tests:
- Complete blood count
- Coagulation profile
- Serum chemistries if indicated
Specimen Collection and Handling
Collection Guidelines
- Minimum 4-6 biopsy specimens recommended
- Proper orientation of specimens essential
- Immediate fixation in appropriate medium
- Separate containers for different anatomical sites
Special Processing Requirements
- Routine histology (Formalin fixed)
- Electron microscopy (Glutaraldehyde)
- Enzyme analysis (Snap frozen)
- Culture studies (Fresh tissue in appropriate media)
Documentation Requirements
- Precise anatomical location of each specimen
- Time of collection
- Special handling instructions
- Clinical information and suspected diagnosis
Potential Complications
Immediate Complications
- Bleeding (most common)
- Perforation (rare, <0.1%)
- Anesthesia-related complications
Delayed Complications
- Post-procedure pain
- Delayed bleeding
- Infection (rare)
Risk Mitigation Strategies
- Proper patient selection
- Adequate pre-procedure preparation
- Careful technique during biopsy
- Post-procedure monitoring
- Clear discharge instructions
