Jejunal Biopsy – Procedure, Indications and Findings

What Is a Jejunal Biopsy?

A jejunal biopsy is a diagnostic procedure in which a small tissue sample is collected from the jejunum – the middle section of the small intestine – and examined under a microscope in a laboratory. The jejunum plays a critical role in the absorption of nutrients, vitamins, and minerals. Structural changes in this section of the gut can have significant consequences for the overall nutritional status of the patient.

When Is a Jejunal Biopsy Performed?

A jejunal biopsy is indicated whenever a disease affecting the small intestinal mucosa is suspected. Common indications include:

• Coeliac disease (gluten-sensitive enteropathy): An autoimmune condition in which gluten causes damage to the intestinal lining. Biopsy is the gold standard for confirming the diagnosis.
• Crohn's disease: A chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract, including the jejunum.
• Tropical sprue: A malabsorption disorder commonly seen in tropical regions.
• Whipple's disease: A rare bacterial infection affecting the small intestine.
• Small bowel lymphoma: To exclude or confirm tumour-related changes.
• Unexplained malabsorption syndromes: Persistent diarrhoea, unintentional weight loss, or nutritional deficiencies of unknown origin.

How Is a Jejunal Biopsy Performed?

The procedure is typically carried out during an upper gastrointestinal endoscopy (gastroscopy) or, for deeper access, a double-balloon enteroscopy. The procedure typically involves the following steps:

• Preparation: Patients are usually required to fast for at least 6–8 hours before the procedure. Medications such as blood thinners should be discussed with the treating physician in advance.
• Sedation: A light sedative is commonly administered to ensure patient comfort throughout the procedure.
• Endoscopy: A thin, flexible tube with a camera (endoscope) is passed through the mouth and advanced into the jejunum.
• Biopsy collection: Using small forceps passed through the working channel of the endoscope, multiple tiny tissue samples (typically 4–6) are taken from the intestinal lining.
• Laboratory analysis: Samples are examined histologically and, if needed, immunohistochemically by a pathologist.

What Does the Tissue Analysis Reveal?

A specialist pathologist examines the tissue samples under a microscope and evaluates the following features:

• Villous atrophy: Shortened or flattened intestinal villi, characteristic of coeliac disease and classified using the Marsh classification system.
• Crypt hyperplasia: Elongation of the intestinal crypts, indicating mucosal damage.
• Inflammatory cells: Increased numbers of intraepithelial lymphocytes or other immune cells, suggesting chronic inflammatory disease.
• Granulomas: Clusters of immune cells characteristic of Crohn's disease or sarcoidosis.
• PAS-positive macrophages: A hallmark finding in Whipple's disease.

Risks and Side Effects

A jejunal biopsy is a well-established and generally safe procedure. However, as with any medical intervention, some minor risks exist:

• Minor bleeding: Small amounts of bleeding at the biopsy site are possible but usually resolve on their own.
• Rare perforation: Injury to the intestinal wall is a very rare but serious complication.
• Sedation reactions: Circulatory or allergic reactions to sedatives can occur but are minimised through monitoring.
• Mild bloating or sore throat after the procedure are common and short-lived.

What Happens After the Procedure?

After the biopsy, patients remain under observation for approximately 1–2 hours until the effects of the sedative have worn off. Mild discomfort such as bloating or a feeling of pressure in the abdomen may occur but typically resolves quickly. Tissue analysis results are generally available within a few days to two weeks and are discussed with the treating physician in a follow-up consultation.

References

1. Rubio-Tapia A, Hill ID, Kelly CP et al. - ACG Clinical Guidelines: Diagnosis and Management of Celiac Disease. American Journal of Gastroenterology. 2013;108(5):656-676.
2. Oberhuber G, Granditsch G, Vogelsang H. - The histopathology of coeliac disease: time for a standardized report scheme for pathologists. European Journal of Gastroenterology and Hepatology. 1999;11(10):1185-1194.
3. Ludvigsson JF, Bai JC, Biagi F et al. - Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology. Gut. 2014;63(8):1210-1228.