PEDIATRICS Vol. 43 No. 3 March 1969, pp. 460-462
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DIAGNOSIS AND TREATMENT: PERORAL INTESTINAL BIOPSY

Harry Shwachman M.D.1, Kon-Taik Khaw M.D.1, and Irene Antonowicz Ph.D.1

1 Division of Clinical Laboratories, The Department of Medicine, Children's Hospital Medical Center, and Departments of Pediatrics of the Harvard Medical School, Boston

Understanding of the function and appearance of the intestinal mucosa in health and disease has rapidly increased with the development of instruments for taking small intestinal biopsies by the oral route. Early studies in the adult, little more than a decade ago, employed a variety of ingenious devices developed by Royer and co-workers,1 Shiner,2 Crosby and Kugler,3 Rubin and co-workers,4 and others. Most of them "sucked up" a bit of the mucosal surface into a small orifice of a capsule, appropriately placed in the intestine, detached the section by a sharp knife blade, and withdrew it in the capsule. Early workers were understandably reluctant to study pediatric patients, but in recent years a number of pediatricians have used these devices effectively.

METHODS

Although the mucosal biopsy obtained from any segment of the small bowel generally weighs only 5 to 15 mg, it may be profitably examined by numerous techniques: the gross morphological, the histological, histochemical, biochemical, and electron microscopic. For routine study, considerable information can be gained by observing the specimen under a dissecting microscope and by histologic examination of carefully oriented and cut sections. Rubin has pointed out the difficulties and errors in interpretation of inadequately prepared sections. The plane of sectioning should be parallel to the villi and perpendicular to the luminal suface. Microtechniques for assay of disaccharidasese can be applied with a high degree of reliability. The activity of lactase, sucrase, maltase, and palatinase can be expressed as activity per unit of wet weight of tissue or per unit of tissue protein content.