Post written by Anouk Overwater, MD, from the Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, and the Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.

The main question of this study is which specimen handling method results in an optimal histopathological evaluation of endoscopic resection specimens of Barrett-related neoplasia. We compared 3specimen handling techniques that are all available for clinical daily practice: (1) pinning on paraffin using needles; (2) direct fixation in formalin; and (3) the cassette technique, a small box in which an endoscopic resection specimen can be stored after stretching it out on paper.

An optimal histopathological evaluation is of utmost importance for patients because it determines the need for additional surgery. Esophagectomy with a stomach tube reconstruction is an invasive surgical procedure with high morbidity and mortality and reduced postoperative quality of life.

The most important finding of our study is that the cassette technique often results in a suboptimal histopathological evaluation. This technique is currently available for clinical daily practice, but its use should be discouraged. The other 2specimen handling techniques, pinning on paraffin and direct fixation in formalin, both result in a high percentage of specimens with an optimal histopathological evaluation. Direct fixation is easy and was associated with the shortest handling time. However, future research with randomization of a larger number of endoscopic resection specimens is required to further compare pinning with direct fixation. Also, all endoscopic mucosal resection specimens should be included in future research. For the current study, we specifically excluded all specimens with suspicion of submucosal invasion because while conducting this study, we found it unethical to risk suboptimal histopathological evaluation for these specimens.

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