Jejunal Biopsy – Definition, Procedure & Significance

What is a Jejunal Biopsy?

A jejunal biopsy is a medical procedure in which a small tissue sample is collected from the jejunum -- the middle section of the small intestine, located between the duodenum and the ileum. The collected sample is then examined under a microscope by a pathologist to identify, confirm, or rule out diseases affecting the small intestine.

When is a Jejunal Biopsy Performed?

A jejunal biopsy is ordered when certain conditions are suspected or when gastrointestinal symptoms remain unexplained. Common indications include:

• Coeliac disease (an autoimmune condition triggered by gluten)
• Crohn's disease (a chronic inflammatory bowel disease)
• Tropical sprue (an infection-related small bowel disorder)
• Whipple's disease (a rare bacterial infection of the small intestine)
• Microscopic colitis and other inflammatory conditions
• Unexplained malabsorption (impaired nutrient absorption)
• Chronic diarrhoea of unknown origin
• Suspected lymphoma or other tumours of the small intestine

How is the Procedure Performed?

A jejunal biopsy is typically carried out during an endoscopy, specifically a gastroscopy or a specialised enteroscopy. A thin, flexible instrument called an endoscope is guided through the mouth into the gastrointestinal tract until the jejunum is reached.

Step-by-Step Procedure

• The patient must fast for at least 6 hours before the procedure.
• A mild sedative may be administered upon request or as clinically indicated.
• One or more small tissue samples are collected using a biopsy forceps passed through the endoscope.
• The procedure is minimally invasive and usually takes only a few minutes.
• Tissue samples are placed in a fixative solution (e.g., formalin) and sent to the laboratory for analysis.

Preparation and Aftercare

Before the procedure, the attending physician will explain the process and any potential risks to the patient. Blood-thinning medications may need to be temporarily discontinued. After the procedure, patients may experience mild throat discomfort or a feeling of pressure in the abdomen, both of which typically resolve quickly.

Risks and Complications

A jejunal biopsy is a safe and well-established procedure. Complications are rare and may include:

• Minor bleeding at the biopsy site
• Infection (very rare)
• Perforation of the intestinal wall (extremely rare)
• Reactions to the sedative medication

Serious complications are very uncommon overall. When the procedure is clearly indicated, the benefit-to-risk ratio is generally very favourable.

Diagnostic Significance

Histological (microscopic tissue) analysis of a jejunal biopsy provides crucial information about the condition of the small intestinal mucosa. In coeliac disease, typical findings include villous atrophy (flattening of the intestinal villi), crypt hyperplasia, and an increased number of intraepithelial lymphocytes. These changes are classified according to the Marsh classification, which describes the severity of mucosal damage.

References

1. Ludvigsson JF et al. - European Society for the Study of Coeliac Disease (ESsCD) Guideline for Coeliac Disease. United European Gastroenterology Journal, 2019.
2. Rubio-Tapia A et al. - ACG Clinical Guidelines: Diagnosis and Management of Celiac Disease. American Journal of Gastroenterology, 2013.
3. Marsh MN. - Gluten, major histocompatibility complex, and the small intestine. Gastroenterology, 1992.