Small bowel biopsy

Alternative names
Biopsy - small bowel

Small bowel biopsy is a diagnostic procedure in which a portion of the lining of the small intestine is removed for examination.

How the test is performed

Small bowel biopsy samples can be obtained by EGD (esophagogastroduodenoscopy) or other endoscopy of the upper gastrointestinal tract. A flexible tube (endoscope) is inserted through your mouth or nose and into the upper gastrointestinal tract. Tissue samples removed during endoscopy are sent to the laboratory for examination.

How to prepare for the test

Preparation for this test is similar to that for an EGD. Fasting for at least 4 hours is recommended. You must sign an consent form.

Infants and children:
The preparation you can provide for this test depends on your child’s age, previous experiences, and level of trust. For general information regarding how you can prepare your child, see the following topics:

  • Infant test or procedure preparation (birth to 1 year)  
  • Toddler test or procedure preparation (1 to 3 years)  
  • Preschooler test or procedure preparation (3 to 6 years)  
  • Schoolage test or procedure preparation (6 to 12 years)  
  • Adolescent test or procedure preparation (12 to 18 years)

How the test will feel

The passage of the tube and capsule often makes a person feel like gagging (topical anesthetic is used to minimize this sensation).

A mild sedative can be given, but only in small doses because the person must remain alert enough to assist with the procedure (by doing such things as swallowing and turning). The biopsy sampling causes little or no pain, although it may cause some mild cramping.

Why the test is performed
This test is most often performed to help diagnose diseases of the small intestines.

Normal Values

Normal small bowel tissue includes finger-like projections (villi), crypts, columnar epithelial cells, and round cells.

What abnormal results mean

Abnormal findings may include:

  • Ulcers  
  • Polyps  
  • Abnormalities of the mucosa or villi (for example, flattening)  
  • Radiation enteritis  
  • PAS positive macrophages  
  • Dilated intestinal lymph nodes or lymphatic vessels

Disorders and conditions that may be indicated by changes found on small bowel biopsy include:

  • Celiac sprue  
  • Coccidiosis  
  • Folate or Vitamin B12 deficiency  
  • Giardiasis  
  • Infectious gastroenteritis  
  • Inflammation of the small bowel  
  • Crohn’s disease  
  • Amyloidosis  
  • Lymphangiectasia  
  • Lymphoma  
  • Malnutrition  
  • Tropical sprue  
  • Whipple’s disease

Additional conditions under which the test may be performed include lactose intolerance.

What the risks are
Complications are rare but may include:

  • Bowel perforation  
  • Excessive bleeding from the biopsy site  
  • Infection of the biopsy site leading to bacteremia (bacteria in the bloodstream)  
  • Vomiting and subsequent aspiration into the lungs

Special considerations
Contraindications (factors that prohibit use of this test) may include uncooperative or confused patients, people taking aspirin or anticoagulants (greatly increases risk of bleeding), and people with untreated coagulation (blood clotting) disorders.

The greatest risk is bleeding. Signs include abdominal pain, blood in the stools, or vomiting blood.

Johns Hopkins patient information

Last revised: December 3, 2012
by Martin A. Harms, M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.