BACKGROUND AND AIMS Diagnosis of GI neuromuscular diseases is mostly on the basis of symptomatology and is often unreliable. Pathologic analysis of affected tissue (eg, the myenteric plexus and muscle) is a potentially valuable method for both diagnosis and advancement of our knowledge about the biologic basis for these syndromes. However, until now access to the deeper layers of the GI tract has been limited, generally requiring invasive surgical techniques. METHODS We report a "close-then-resect" endoscopic full-thickness biopsy sampling (EFTB) technique using an over-the-scope clip and telescope for rectal muscle biopsy sampling in patients with suspected severe neuromuscular gut disorders. The main outcome measures were technical success and adverse events. RESULTS Thirteen patients (11 women; mean age 27 ± 5.4 years) with diffusely delayed colonic transit underwent EFTB. The mean (± standard deviation) procedure time was 30 ± 5.2 minutes. The mean size of the resected specimen was 18 ± 3.5 mm. Histologic full-thickness tissue samples were achieved for all patients. Postprocedural adverse events were reported in 2 patients, and both were graded as mild (1 self-limited bleeding and 1 with rectal pain). Hematoxylin and eosin staining of tissue samples confirmed adequate cross-sectional imaging of muscularis propria in all patients with excellent demonstration of the myenteric plexus and both layers of muscle. Two patients demonstrated a decrease in interstitial cells of Cajal as demonstrated by CD117 staining. No cases demonstrated appreciable inflammation involving myenteric ganglia. CONCLUSIONS Diagnostic EFTB with modified over-the-scope clip for the close-then-resect method appears to be a safe and effective technique to obtain adequate full-thickness rectal specimens, allowing for both quantitative and qualitative analysis for the diagnosis of neuromuscular GI dysmotility.

中文翻译：

---

内窥镜全层肌肉活检对严重肠动力异常患者的直肠组织取样：初步经验（视频）。

背景和目的胃肠道神经肌肉疾病的诊断主要是基于症状学，并且通常是不可靠的。对受影响的组织（例如，肌间神经丛和肌肉）进行病理学分析是诊断和提高我们对这些综合征的生物学基础知识的潜在有价值的方法。然而，直到现在，进入胃肠道深层的途径仍然受到限制，通常需要侵入性外科手术技术。方法我们报告了一种“先关闭后切除”内窥镜全层活检样本（EFTB）的技术，该技术使用超广角镜夹和望远镜对怀疑患有严重神经肌肉性肠病的患者进行直肠肌肉活检。主要结果指标是技术成功和不良事件。结果13名患者（11名女性；平均年龄27±5。4年）结肠延迟弥漫性转移接受了EFTB。平均（±标准偏差）操作时间为30±5.2分钟。切除标本的平均大小为18±3.5毫米。所有患者均获得组织学全层组织样品。据报道有2例患者发生了术后不良事件，并且均被定为轻度（1例自限性出血和1例伴有直肠疼痛）。苏木精和曙红染色的组织样品证实了所有患者的固有肌横断面成像，并具有肌层神经丛和两层肌肉的出色表现。如CD117染色所示，两名患者表现出Cajal的间质细胞减少。没有病例显示出可累及的肌间神经节炎症。