Biopsy Specimens

Flexible endoscopy is the cornerstone for investigation and diagnosis of gastric-related symptoms. Biopsies for gastritis should be taken according to the Sydney protocol from antrum, body and incisura and any abnormal areas. Specific lesions such as ulcers need multiple biopsies from the base and margin quadrants. A peptic ulcer has a classic endoscopic appearance in that it is round/oval and sharply "punched out" with straight walls. Heaping up of mucosal margins is rare in benign ulcers and should raise the suspicion of malignancy. Size does not reliably differentiate between benign and malignant ulcers as 10% of benign ulcers are greater than 4 cm in diameter. Tumours covered by intact mucosa such as diffuse gastric carcinoma or GISTs are often difficult to demonstrate by mucosal biopsy and endoscopic FNA may be employed.

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