When the gross endoscopic appearance reveals a specific condition, tissue analysis is unnecessary if therapy will not be altered. Tissue biopsy should be avoided when there is an increased potential for hemorrhage. Numerous techniques and devices have been designed to obtain adequate tissue samples. Pinch biopsy is done with biopsy forceps and is the most commonly used form of tissue sampling. Snare excision is used for removal of large polyps.
Adequate tissue sampling sometimes requires a combination of techniques.
Pinch biopsy has the highest diagnostic yield for ulcerative or polypoid masses. Multiple biopsies should be obtained from the edge of each quadrant of an ulcer. Polypoid lesions should be biopsied, and polyps greater than 2 cm should be removed when technically feasible. The addition of a fine needle aspirate may yield a diagnosis which would be difficult to obtain without full thickness biopsy. Patients with persistent or recurrent dyspepsia may require upper endoscopy and biopsy.