1. Michelle Coker, HT(ASCP) cm Laboratory Manager Austin Gastroenterology

2. Objectives Identify what types of specimens can be collected during an EGD/colonoscopy Know common tests that might be ordered on samples from the EGD/colonoscopy Know what constitutes an adequate specimen for different testing Be able to identify what type of transport medium the specimen should be placed in based on testing Know which specimens need to be sent to the lab immediately and which can wait

3. Have you ever been asked to obtain samples for testing you are unfamiliar with??? There are many types of lab testing that can be done on tissue samples obtained during the EGD/colonoscopy procedure. Sometimes, nurses and technicians are asked to obtain samples for tests they are not familiar with. Today, we will increase your awareness of these specimens and how to collect them correctly.

4. Tissue Biopsies Brushings Fecal/stool Foreign object/foreign body removal

5. Most Common Type of Specimen is Tissue Biopsies Esophagus Gastric/Stomach Duodenum/small bowel Cecum Colon Rectum These specimens can be submitted for routine pathology or a variety of other tests.

6. Other Specimens that can be collected during a procedure Brushings-most common locations: Esophagus Bile duct rectum Fecal/stool samples Foreign Body Removal These specimens will be submitted to the lab, but not for routine Histology

7. Routine Pathology Flow Cytometry Bacterial Cultures Viral Cultures Brushings for cytology Brushings for bacterial/viral cultures Fecal/Stool samples Foreign Body Removal

8. Routine Pathology Collection Transport medium is 10 % Neutral Buffered Formalin Place the specimen in formalin as soon as possible to prevent autolysis (cellular breakdown) Specimen may be kept in formalin indefinitely with no adverse effects on testing

9. Labeling for any specimen The vast majority of errors with the specimens involve labeling problems At a minimum, the label must have the following information: Patient name Medical record number Date of birth Physician Date and time of collection Site of collection

10. The specimen site is often the labeling error Examples of good site labeling: Gastroesophageal junction biopsy Stomach body biopsy Ascending colon polyp Colon @ 30 cm biopsy Gastric body anastamosis site biopsy Examples of bad site labeling: Anastamosis biopsy Body biopsy @ 29 cm biopsy Biopsy r/o h.Pylori Polyp r/o “fill in the blank”

11. It is imperative to collect an adequate sampling to obtain a reliable test result!!

12. Examples of Adequate vs. Inadequate Photo of adequate specimens Photo of inadequate specimens

13. Diagram of GI tract Regions Esophagus Barrett’s Esophagus. (2015). Retrieved from http://www.barrettsinfo.com/content/3b_what_is_histology.cfm http://www.barrettsinfo.com/content/3b_what_is_histology.cfm

14. Diagram of GI Tract Regions Stomach stomach. (2015). In Encyclopædia Britannica. Retrieved from http://www.britannica.com/EBchecked/topic/567085/stomach http://www.britannica.com/EBchecked/topic/567085/stomach

15. Diagram of GI Tract Regions Small Instestine (Duodenum) and Large intestine Chapter 23. (2015). Retrieved from https://facweb.northseattle.edu/jlearn/BIOL_241_242/Ch_23b_ Digestive.htm https://facweb.northseattle.edu/jlearn/BIOL_241_242/Ch_23b_ Digestive.htm

16. Specimens other than Routine Pathology As mentioned before there are many other types of specimens you may be asked to collect. Some things to remember: If you don’t know what testing is required, a sterile piece of gauze moistened with sterile saline in a sterile urine container will preserve the specimen long enough for you to find out. You should always have a contact at the laboratory that does your pathology/microbiology testing that you can call with questions. It is best if you can call before the procedure, but after will work as long as the specimen is dealt with expeditiously.

17. Flow Cytometry Flow cytometry is testing done when the physician feels there may be a risk of lymphoma. The test results are far more effective to diagnose lymphoma than just pathology alone. The two reports are generally correlated by the pathologist. Flow cytometry can be done on tissue, blood, or body fluids from the area of the suspected lesion.

18. Bacterial Cultures Bacterial cultures are often done during the colonoscopy to detect any abnormal bacteria in the GI tract. Method of collection is vital to obtaining accurate results. Collection must be sterile.

19. Viral Cultures Very similar to bacterial cultures, viral cultures are done often during a colonoscopy. Again, collection methods are of vital importance.

20. BRUSHINGS Brushings can be done for cytology, as well as bacterial and viral cultures. Brushings are often done in areas where biopsies are contraindicated.

21. FECAL/STOOL SAMPLES Fecal/stool samples can be collected for various reasons. Sometimes the physician wants an occult blood test, sometimes he wants an ova and parasite test done. First, find out exactly what type of testing the physician wants. This will determine how you hand the sample. It’s always wise to use sterile containers in case the physician decides to add on any testing after collection is done.

22. FOREIGN BODY EMOVAL Foreign body removal happens occasional during colonoscopies. When a foreign body is removed, it is sent to the lab to document and issue a report regarding what was removed from the colon. It can be materials ingested by the patient or can be the removal of a stent. The item can be retrieved from the lab after the case is signed out and a release form is signed.

23. Q&A Question and answer time…