Mucosal and Full Thickness Biopsy Evaluations


Briefly: Full Thickness biopsies of the GI tract have been both intriguing and inaccessible. In the past the main source of these biopsies were in resected surgical specimens. Over the last several decades, the interest and ability to evaluate full thickness biopsies of the GI tract has increased.

History:  The interest in full thickness biopsy evaluation of the GI tract has paralleled both the advances in neuro-muscular disease elsewhere in the body, as well as understanding of many component of the enteric nervous system. Our team has been involved with full thickness biopsies for over 25 years. More recently we have been interested in mucosal biopsies for nerve fiber localization, in conjunction with colleagues at the U of MN and elsewhere.
Projects:  Full thickness biopsies were collected from patients with unexplained nausea and vomiting who were having surgical operations for many different reasons, esp. for enteral access tubes. The techniques for staining were limited at first but have increases, esp. with the widespread ability to stain for CD—177 or C-kit as a way to identify interstitial cells of Cajal (ICCs). This work has accelerated as other stains have been adapted and a number of national, international center have become involved, including  NIH funded projects in the US.

Original Publications, chronologically (including NIHGPCRC *** data):
Abell TL, Familoni B, Voeller G, Werkman R, Dean P, Waters B, Smalley D, Salameh JR.  Electrophysiologic, morphologic and serologic features of chronic unexplained nausea and vomiting:  Lessons learned from 121 consecutive patients.  Surgery. 2009: 145 (5); 476-485

Grover M, Farrugia G, Lurken MS, Bernard CE, Faussone-Pellegrini MS, Smyrk TC, Parkman HP, Abell TL, Snape WJ, Hasler WL, Unalp-Arida A, Nguyen L, Lee L, Tonascia J, Hamilton FA, Pasricha PJ and the NIDDK Gastroparesis Clinical Research Consortium.  Cellular changes in diabetic and idiopathic gastroparesis.  Gastroenterology, 2011; 140: 1575-1585. ***

Maria Simonetta Faussone-Pellegrini, Madhusudan Grover, Pankaj J Pasricha, Cheryl E Bernard, Matthew S. Lurken, Thomas C Smyrk, Henry P Parkman, Thomas L Abell, William J Snape, William L Hasler, Aynur Unalp-Arida, Linda Nguyen, Kenneth L Koch, Jorges Calles, Linda Lee, James Tonascia, Frank A Hamilton, Gianrico Farrugia:  Ultrastructural differences between diabetic and idiopathic gastroparesis.  The NIDDK gastroparesis clinical research consortium (GpCRC)(#†)  [show abstract] Journal of Cellular and Molecular Medicine 09/2011; 16(7):1573-81.  doi: 10.1111/j.1582-4934.2011.01451***

O’Grady G, Angeli TR, Du P, Lahr C, Lammers WJ, Windsor JA, Abell TL, Farrugia G, Pullan AJ, Cheng LK:  Abnormal initiation and conduction of slow-wave activity in gastroparesis, defined by high-resolution electrical mapping.  Gastroenterology. 2012 Sep;143(3):589-98.e1-3. doi: 10.1053/j.gastro.2012.05.036. Epub 2012 May 27. (***)

Grover M, Bernard CE, Pasricha PJ, Lurken MS, Faussone-Pellegrini MS, Smyrk TC, Parkman HP, Abell TL, Snape WJ, Hasler WL, McCallum RW, Nguyen L, Koch KL, Calles J, Lee L, Tonascia J, Ünalp-Arida A, Hamilton FA, Farrugia G:  Clinical-histological associations in gastroparesis: results from the Gastroparesis Clinical Research Consortium.  NIDDK Gastroparesis Clinical Research Consortium (GpCRC).  Neurogastroenterol Motil. 2012 Jun;24(6):531-9, e249. doi: 10.1111/j.1365-2982.2012.01894. ***

Christopher J Lahr, James Griffith, Charu Subramony, Lindsey Halley, Kristen Adams, Elizabeth R Paine, Robert Schmieg, Saleem Islam, Jay Salameh, Danielle Spree, Truptesh Kothari, Archana Kedar, Yana Nikitina, Thomas Abell:  Gastric electrical stimulation for abdominal pain in patients with symptoms of gastroparesis.  The American surgeon 05/2013; 79(5):457-64.

Abstracts (numerous—available on request—some are listed below)

Abell TL, Familoni J, Duncan U, Waters B, Dean P, Voeller, G: Operative Evaluation of 24 patients with the symptoms of gastrointestinal dysmotility. Soc Surg Alimentary Tract (523), p. 118, 1993.

Abell TL, Familoni J, Dean P, Voeller G, Duncan U, Waters B: Prospective    Intraoperative evaluation of 21 patients with the symptoms of gastrointestinal

dysmotility. Presented, II United European Gastroenterology Week, Barcelona, Spain, July 1993.

Abell TL, Waters B, Duncan U, Familoni BO, Cardoso S. Voeller G, Dean P. Intraoperative electrophysiology and full thickness biopsy provide useful diagnostic information in patient with refractory nausea and vomiting. Gastroenterology 106(Part 2): A1, 1994, Presented at the AGA National Meeting, 1994.

Bhaskar SK, Abell TL, Smalley D, Familoni. Voeller G. Correlation of full

thickness biopsies and serum autoantibody scores in patients with unexplained nausea and vomiting. Gastroenterology 110(4): A634, 1996.

Bhaskar SK, Abell TL, Dean P, Voeller G. Comparison of intraoperative small bowel electrophysiology and full thickness biopsy. Presented, International Workshop on Electrogastrography, May 23, 1996.


Abell TL, Chiang G, Familoni J, Voeller G, Bhaskar S, Nash K, Dean P. Patients with Unexplained Nausea and Vomiting have a High Incidence of Morphologic and Electrophysiologic Abnormalities. Gastroenterology 92 (9) 1652, September 1997

Deshmukh SL, Nash K, Familoni J, Smalley D, Voeller G, Dean P, Abell TL. Can Non-Histologic Techniques predict Visceral Myopathies or Neuropathies (DDW, May 15-22, 1998, New Orleans, LA).

Current focus: is on less invasive techniques to evaluated GI neuromuscular function including mucosal biopsies and in some cases fine needle biopsies. A number of ongoing studies hope to enable clinicians to better evaluate GI neuromuscular status of individual patients.


[updated 18 June 2014 by TLAbell]

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