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Intestinal Biopsy – Procedure, Indications & Results

An intestinal biopsy is a medical procedure in which a small tissue sample is taken from the lining of the bowel and examined in a laboratory to diagnose intestinal diseases.

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Things worth knowing about "Intestinal Biopsy"

An intestinal biopsy is a medical procedure in which a small tissue sample is taken from the lining of the bowel and examined in a laboratory to diagnose intestinal diseases.

What Is an Intestinal Biopsy?

An intestinal biopsy is a diagnostic procedure in which a tiny tissue sample is removed from the lining of the bowel (intestinal mucosa). This sample is then examined under a microscope by a pathologist to detect abnormal changes in the tissue. Intestinal biopsies are a standard method in modern gastroenterology and provide critical diagnostic information that imaging techniques alone cannot offer.

When Is an Intestinal Biopsy Performed?

An intestinal biopsy is used for various clinical indications. Common reasons include:

Suspected inflammatory bowel disease (IBD), such as Crohn's disease or ulcerative colitis
Diagnosing coeliac disease (gluten intolerance)
Suspected colorectal cancer or precancerous lesions (e.g., polyps)
Unexplained chronic diarrhoea or malabsorption syndromes
Monitoring after bowel transplantation
Suspected microscopic colitis
Investigation of infectious bowel conditions

How Is an Intestinal Biopsy Performed?

Tissue samples are typically collected during an endoscopic procedure – either a colonoscopy (examination of the large bowel) or a gastroscopy with duodenoscopy (examination of the upper digestive tract). The physician inserts a thin, flexible instrument with a camera (endoscope) into the bowel. Through a working channel in the endoscope, a small forceps is used to painlessly remove tiny tissue fragments.

Preparation

Preparation depends on the area being examined. For a colonoscopy, the patient must completely empty the bowel using a laxative solution. For a gastroscopy, fasting for several hours beforehand is sufficient. Patients should inform their doctor about blood-thinning medications or other relevant drugs in advance, as adjustments may be necessary.

The Procedure

The procedure is usually performed under light sedation, so the patient experiences little to no discomfort. The actual tissue removal is painless, as the intestinal mucosa does not contain pain receptors. The collected samples are preserved in a fixative solution and sent to a pathology laboratory. Results are typically available within a few days.

Which Parts of the Bowel Can Be Biopsied?

A biopsy can be taken from almost any section of the gastrointestinal tract:

Small intestine (particularly the duodenum) – e.g., for suspected coeliac disease
Large intestine (colon) – e.g., for Crohn's disease, ulcerative colitis, or polyps
Rectum – e.g., for proctitis or rectal tumours
Terminal ileum (last segment of the small intestine) – particularly relevant for Crohn's disease

What Do Biopsy Results Show?

The pathology laboratory examines the tissue sample for various types of changes:

Inflammatory changes: The type and extent of inflammation provide clues to specific diseases.
Structural changes: For example, villous atrophy in coeliac disease (flattening of the intestinal villi).
Cellular changes: Precancerous changes (dysplasias) or malignant cells can be identified.
Pathogens: Certain bacteria, viruses, or parasites can be detected within the tissue.

Risks and Complications

An intestinal biopsy is a safe and well-established procedure. Serious complications are rare but may include:

Minor bleeding at the biopsy site
Rarely: perforation (piercing of the bowel wall) – extremely uncommon when performed by experienced endoscopists
Mild abdominal cramping or bloating after the procedure

After the procedure, patients should allow adequate time to recover, especially if sedation was administered. Driving a vehicle on the day of the examination is not permitted.

References

European Society of Gastrointestinal Endoscopy (ESGE) – Guidelines on Colonoscopy and Biopsy Techniques, 2022.
Rubio-Tapia A. et al. – ACG Clinical Guidelines: Diagnosis and Management of Celiac Disease. American Journal of Gastroenterology, 2023.
World Health Organization (WHO) – Guidelines for the Diagnosis and Management of Inflammatory Bowel Disease, 2022.

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