Gastroenterologist/pathologist partnership

Gastrointestinal biopsies provide critical information to gastroenterologists in patient management. The responsibility of the pathologist is to provide the optimum pathology report on these biopsies. However, the pathologist is dependent on the gastro-enterologist to provide certain information and to obtain the most diagnostic tissue. Key information includes a brief clinical history, which focuses the pathologist's examination of slides and directs any ancillary special pathologic studies. A valuable part of the clinical history includes information on the use of certain drugs. It is crucial for the pathologist to know certain key endoscopic findings, starting with the site of the biopsy, specifying exact location (eg, antrum, not just stomach.) In some diseases, certain biopsy techniques greatly influence the yield of positive biopsies. For example, in an ulcer from an AIDS patient, both the base as well as the edges of the ulcer must be biopsied as different viruses will be found in the different sites. For a submucosal lesion, a bite-on-bite technique or an endoscopic ultrasound with fine needle aspiration may facilitate the diagnosis. Minimizing or avoiding practices or procedures that damage tissue is also critical. Finally, some clinical conditions require ancillary studies that cannot be performed on formalin fixed tissue. Alerting the pathologist ahead of time will help insure that the proper harvesting and storage of tissue is followed for these special procedures.