Study and Methods

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Results

Comments

Frimberger, et al. [6] Compares the sample size of a SBB (n = 79) with the sample size of a DBB (n = 79) colorimetric measurement of protein quantity was done. Spiked and un-spiked forceps used.

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DBB increased the average protein content by 43% (p < 0.01). Forceps with a spike yielded a double sample in every case.

Balanced randomised design with representative samples from all regions yet it is an indirect study. Clinical is questionable.

Padda, et al. [8] Prospectively assess the adequacy of mucosal biopsy specimens (n = 288) i.e. SBB and DBB.

16

No difference between DBB (n = 192) and SBB (p < 0.05). SBB more prone to loss.

One pathologist, hence, no intra-observer variability. It was, however, a low powered the power study.

Fantin, et al. [9] Prospective, partially blinded, and randomized. Multi-bite (n = 510) and conventional (n = 520) forceps. Diameter, depth, artifacts, orientation, diagnostic quality.

250

Specimens obtained with both forceps are comparable in relation to diagnostics quality (p < 0.05).

Better definition of histological standards i.e. diameter, depth, artefacts, orientation. The study evaluated the efficacy multi byte forceps rather than technique per se.

Chu, et al. [10] It was well designed prospective study (n = 240) and the pathologists were blinded. Compared for SBB DBB.

40

No difference noted. Larger specimens were collected with alligator forceps and SBB saves time.

Detailed definition of histological standards was given. Evaluated the efficacy forceps rather than technique.

Zaidman, et al. [11] Porcine models comparing SBB and multiple bites for time taken and tissue quality. Pathologists (x2) blinded.

36

Multi-bite forceps faster (8.5 M) in comparison to SBB (13.3 M). No histological differences noted.

Indirect study where animal model was used. DBB was not compared.

Edery, et al. [13] Canine model comparing depth, crush artifacts and diagnostic using SBB and multi-bite forceps.

21

Gastric (n = 21) and duodenal (n = 20) biopsies and no significant difference was noted.

Indirect study where animal model was used. DBB was not compared.

Stern, et al. [12] Comparing diameter, depth, crush artifacts and specimen loss in SBB and DBB upper, lower GI tract.

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OGD (n = 18) and Colon (n = 11). SBB (n = 69) larger than DBB (n = 59) (p < 0.05). No difference noted.

The study collected specimens from different regions. Low powered study and lack of full publication.

Hookey, et al. [14] To determine the effectivity of DBB in detecting dysplasia in ulcerative colitis. Two pathologists blinded to the biopsy technique examined each biopsy.

12

DBB specimens were inadequate for dysplasia assessment (OR = 2.78, 95% CI 1.37 to 5.59; P < 0.05). Tissue loss was more in DBB.

Clinically relevant study. The power of the study was low, and dysplasia is a patchy pathology in UC, hence comparison might have been biased.

Pappas, et al. [18] Yield of SBB and DBB for Surveillance of HDGC and comparison of time taken to collect biopsies. Prospectively randomized.

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DBB size < SBB (2.5 mm vs. 3.0 mm; P <  0.001) but did not affect the surveillance. Time taken by DBB < SBB (p < 0.05).

Only used biopsies in one region which may have affected measurements of biopsy time i.e. taking biopsies in stomach is relatively easy.

Latorre, et al. [16] To compare DBB and SBB for orientation, consecutive crypt-to-villous units, and Marsh score DBB in patients with confirmed (n = 40 and suspected coeliac disease (n = 31).

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66% of patients with the single-biopsy technique and 42% of patients with the double-biopsy technique had good orientation (P < 0.01).

Decisive conclusion to use only SBB method but the study excluded duodenal bulb biopsies from analysis which is used in the diagnosis of coeliac disease.

Amaro, et al. [7] USA To compare DBB and SBB in terms of the histologic evaluation of the small bowel biopsy.

30

SBB (70%) > deep DBB (65%) but no difference between the histologic diagnosis of small bowel.

SBB were better quality wise. The study only examined one area i.e. small bowel.