Endoscopy and biopsy

Endoscopy and biopsy

Flexible endoscopy is one of the world’s most common examination methods. It involves inserting a flexible, tube-like camera instrument into the body’s natural openings to investigate the cause of the patient’s problems. The endoscope has a camera with lighting to look in the area being examined, as well as an instrument channel for flexible instruments that, among other things, makes it possible to collect samples of the suspected tumour tissue.

During the examination, samples (biopsies) are taken from the organs and from any suspicious changes that are discovered. The samples are then sent for analysis to determine whether there is cancer, for example. The quality of the biopsy is crucial in order to determine whether the patient has cancer and, if so, what type. If the sample is of poor quality or is too small, re-examination might be required or more complicated and risky methods considered. Flexible endoscopy became popular in clinical practice in the 1970s, and has since revolutionised the diagnosis and treatment of cancers. The organs most commonly examined by means of flexible endoscope are the gastrointestinal tract and the lungs. BiBB develops flexible disposable instruments for the sampling of these.

Today’s biopsy instruments are disposable products in the form of needles (referred to as EUS-FNA/FNB, EBUS-TBNA) and small forceps. The doctor collects a number of biopsies via the endoscope. These are then sent to the pathology lab for analysis. At pace with the growth of modern individualised treatment of various forms of tumours, increasing demands are being placed for accurate diagnosis prior to the start of treatment.

Since 2020, BiBB has been focused on needle instruments (EUS-FNA/FNB, EBUS-TBNA) used in endoscopes with ultrasound, which is the fastest-growing area in endoscopy. Read more about EUS and EBUS instruments below.

Even though ultrasound-guided needle instruments have been refined over the past two decades, they usually only collect tissue fragments or a daub of detached cells. The lack of high-quality cohesive core biopsies is the missing link in the cancer diagnostics chain.

EndoDrill® Model X meets an important clinical need by taking core biopsies that enable complete diagnosis at the very first examination.

High-quality core biopsies acquired by EndoDrill® Model X

Ultrasound endoscopy – EUS and EUS-FNA/FNB

Endoscopic ultrasound (EUS) means that the flexible endoscope is also equipped with ultrasound to be able to see deeper into the organs and surrounding tissue. With guidance from the ultrasound, representative samples can be collected safely.

Endoscopic ultrasound is used by gastroenterologists/surgeons for cancer diagnosis and staging of unclear, small, deep and difficult-to-access tumour changes. Samples are collected with fine needles, either fine needle aspiration (EUS-FNA, cytological sample) or biopsy (EUS-FNB, histological sample). The method has developed rapidly over the past two decades and is now used in suspected cancer from the upper gastrointestinal tract down to the rectum, such as in the oesophagus, stomach, pancreas, bile ducts, gall bladder, adrenal glands and rectum. High-quality samples are needed for diagnosis and staging, and to determine suitable treatment (tumour-shrinking treatment, surgery, chemotherapy, radiation, etc.).

Due to its minimally invasive nature, EUS has become the fastest growing endoscopic segment with an ever-growing number of indications. EUS has also become increasingly used as a therapeutic method, such as drainage of cysts in the pancreas.

Endobronchial ultrasound – EBUS and EBUS-TBNA

Ultrasound in combination with bronchoscopy is used in suspected lung cancer and is then called EBUS, endobronchial ultrasound. EBUS is used by pulmonologists as a complement to CT and PET in the diagnosis of central and peripheral lung changes, for example in case of suspicion that lung cancer has spread to the mediastinal lymph nodes. Once the change has been localised, fine needles (EBUS-TBNA) can be used via the major airways to take samples. Sampling is often absolutely decisive for whether a curative operation can be performed.

EBUS-TBNA enables diagnosis of lymph nodes deep inside the chest as well as central lung tumours. In just a short time, the procedure has made its way into all international guidelines, and is now the method of choice for staging metastasized lung cancer. It is sometimes necessary to map out a larger area for complete staging. In such case, endoscopic ultrasound of the airways (EBUS-TBNA) and the oesophagus (EUS-FNA / FNB) are combined.