Michelle Coker, HT(ASCP)cm
Laboratory Manager
Austin Gastroenterology
Objectives
 Identify what types of specimens can be collected during
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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
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.
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Tissue Biopsies
Brushings
Fecal/stool
Foreign object/foreign body removal
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.
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
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Routine Pathology
Flow Cytometry
Bacterial Cultures
Viral Cultures
Brushings for cytology
Brushings for bacterial/viral cultures
Fecal/Stool samples
Foreign Body Removal
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
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
The specimen site is often the
labeling error
 Examples of good site
labeling:
 Gastroesophageal
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
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”
It is imperative to collect an adequate
sampling to obtain a reliable test
result!!
Examples of Adequate vs.
Inadequate
Photo of adequate
specimens
Photo of inadequate
specimens
Diagram of GI tract Regions
Esophagus
Barrett’s Esophagus. (2015). Retrieved from
http://www.barrettsinfo.com/content/3b_what_is_histology.cfm
Diagram of GI Tract Regions
Stomach
stomach. (2015). In Encyclopædia Britannica. Retrieved from
http://www.britannica.com/EBchecked/topic/567085/stomach
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
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.
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.
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.
Viral
Cultures
Very similar to
bacterial cultures,
viral cultures are
done often during
a colonoscopy.
Again, collection
methods are of
vital importance.
BRUSHINGS
Brushings can be
done for cytology,
as well as bacterial
and viral cultures.
Brushings are
often done in areas
where biopsies are
contraindicated.
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.
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.
Q&A
 Question and answer time…