A Biopsy Was Taken at My Endoscopy: What Does It Mean?

When the doctor takes a small tissue sample during a gastroscopy or colonoscopy, it is called a biopsy. The sample taken is examined under the microscope in a pathology laboratory.

What worries patients most is this:

Why is a biopsy taken at endoscopy?

There are many different reasons for a biopsy. For example:

• To look for Helicobacter pylori
• To assess the type and grade of gastritis
• To look for atrophic gastritis or intestinal metaplasia
• To assess coeliac disease
• To examine suspected oesophagitis or Barrett’s oesophagus
• To assess inflammatory bowel disease
• To determine the nature of a polyp or another lesion
• To find out whether a suspicious area is benign or malignant

Sometimes a biopsy is taken even from an area that looks entirely normal at endoscopy.

How is a biopsy taken?

Tissue samples a few millimetres across are taken from the lining with a very small biopsy forceps passed through the endoscope. Pain is generally not felt during the procedure.

The pieces taken are placed in special containers and sent to the pathology laboratory:

Endoscopy → biopsy → pathological examination → result

What does a biopsy from the stomach look for?

Stomach biopsies most often look for H. pylori, chronic gastritis, activity, atrophy, intestinal metaplasia, dysplasia and, where needed, tumour changes.

So “biopsies were taken from the antrum and corpus” on a report does not on its own show that a serious condition was suspected.

Why is a biopsy taken from the duodenum?

A duodenal biopsy matters particularly when coeliac disease is being investigated.

The structure of the villi, villous atrophy and inflammatory changes are assessed. A biopsy may also be needed when investigating some infections and rarer bowel conditions.

Why is a biopsy taken from the oesophagus?

A biopsy from the oesophagus may be taken to assess conditions such as Barrett’s oesophagus, eosinophilic oesophagitis, infection, and suspicious strictures or lesions.

Can a biopsy be taken from a normal-looking area at colonoscopy?

Yes.

When chronic diarrhoea is being investigated, for instance, the colon can look entirely normal at endoscopy. Even so, biopsies may be taken from different regions to look for conditions such as microscopic colitis, which can only be seen under the microscope.

So the answer to “nothing was seen at endoscopy, so why did they take a biopsy?” is usually: to look for conditions that can be seen only with a microscope.

Does taking a biopsy spread cancer?

No.

The idea that a standard biopsy taken with proper technique at gastrointestinal endoscopy “disturbs or spreads cancer” is not correct.

Where there is a suspicious lesion, a biopsy is often extremely important for making the right diagnosis.

Is a biopsy dangerous?

Standard mucosal biopsies are generally very low-risk procedures.

A small amount of bleeding can occur at the biopsy site and mostly stops on its own. Serious bleeding is rare.

When does the pathology result come back?

The time varies with the centre. It can take longer where special stains, immunohistochemistry or further assessment are needed.

The work is not finished when the pathology report arrives; the result needs weighing together with the endoscopy findings.

Which words might you meet in a pathology report?

A report can contain many phrases: chronic gastritis, active gastritis, H. pylori, atrophy, intestinal metaplasia, dysplasia, villous atrophy, an increase in eosinophils. Each of these means something different.

Seeing the words “metaplasia”, “atrophy” or “dysplasia” in particular does not automatically mean “cancer”.

Remember

• A biopsy Is the examination of a small tissue sample under the microscope.
• A biopsy being taken Does not mean there is cancer.
• To look for H. pylori A biopsy is often taken.
• Even when the endoscopy is normal A biopsy may be needed to look for some conditions.
• A biopsy Does not spread cancer.
• The pathology result Has to be weighed together with the endoscopy findings.