Norm of Cytologic Study of Gastrointestinal Tract
Normal cells of the gastrointestinal tract. No tumor cells or infection.
Usage of Cytologic Study of Gastrointestinal Tract
Cytologic examination of exfoliation of the mucosa of the gastrointestinal tract to allow diagnosis of benign, precancerous, or malignant lesions of the esophagus, stomach, and duodenum. Also for amyloidosis, microscopic colitis, Crohn's disease, granulomatous inflammation, gastritis, Helicobacter pylori, leiomyosarcoma, lymphoma, intestinal spirochetosis, melanosis coli, Ménétrier's disease, pernicious anemia, schistosomiasis, toxic drug effect on gastric mucosa, and Whipple's disease.
Description of Cytologic Study of Gastrointestinal Tract
Brushings or fine-needle aspirations of the mucosa of the upper gastrointestinal tract are performed during endoscopic examination. Washings of the mucosa for a specimen through a nasogastric tube may be performed when endoscopy is not available or is contraindicated or when neoplasm is clinically suspected. Brushings of the colon or rectum can be made by proctosigmoidoscopy.
Professional Considerations of Cytologic Study of Gastrointestinal Tract
Consent form NOT required for nasogastric tube method. Consent form IS required for endoscopy and sigmoidoscopy.
See individual procedures for risks and contraindications.
Severe gastrointestinal bleeding, varices (gastric or esophageal), and clients who are unable to cooperate.
- Preschedule this test with the laboratory.
- If colon washing is to be performed, administer an oral cathartic as prescribed and collect the last bowel movement before the test to send to the laboratory with the washing specimen.
- For collection of gastric washings for cytologic examination, obtain a nasogastric (NG) tube, a lubricant, 0.9% saline, a syringe, a 500-mL clean container, a 50% ethyl alcohol (ethanol) fixative, and dry ice.
- For collection of endoscopic brushings for cytologic examination, obtain endoscopic equipment, a brush, glass slides labeled with the client's name, a clean container of 95% ethyl alcohol or other fixative required by the specific laboratory, and dry ice or 50% ethyl alcohol.
- For colon washing, obtain an enema tube, 0.9% saline, a large airtight plastic container, and dry ice or 50% ethyl alcohol.
- See Upper gastroduodenojejunoscopy; Barium enema; Proctoscopy or Sigmoidoscopy for other preparations, as would be appropriate for the procedure being performed.
- Gastric washing:
- a. Insert a nasogastric tube.
- b. Withdraw gastric contents with a Toomey syringe and discard.
- c. Instill 300–500 mL of 0.9% saline solution into the stomach through the NG tube.
- d. Have the client roll 360 degrees four or five times.
- e. Aspirate all the gastric contents into a clean, sealed container.
- Endoscopic brushings for cytology:
- a. During endoscopy, a brushing is taken from specific lesions of the esophagus, the stomach, or the duodenal area.
- b. The brush should be rolled onto a slide to cover at least a 1.5-cm-diameter area.
- c. The slide should be immediately placed into a container of 95% ethyl alcohol (ethanol) or other required fixative.
- Colon washing: Colon washing is performed just before barium enema washing.
- a. Insert the enema tubing into the colon through the rectum.
- b. Instill 100 mL of 0.9% saline solution through the tubing.
- c. Have the client roll 360 degrees several times.
- d. Drain the fluid out of the enema tubing and instill it into an airtight container.
- Colon or rectal brushing:
- a. Insert the proctoscope or sigmoidoscope.
- b. Take a brushing from the lesion sites.
- c. The brush should be rolled onto a slide to cover at least a 1.5-cm-diameter area.
- Either pack the specimen in dry ice or preserve it with 50% ethyl alcohol.
- Write the time and source of the specimen collection on the laboratory requisition. Each separate brushing sample should be labeled with the anatomic site of collection.
- Transport the specimen to the cytotechnologist in the pathology laboratory immediately for fixing and microscopic examination.
- Remove the nasogastric or enema tube.
- Resume normal diet.
- See Upper gastroduodenojejunoscopy; Barium enema; Proctoscopy or Sigmoidoscopy for other postprocedure care, as appropriate for the procedure being performed.
Client and Family Teaching
- Eat a soft diet for the evening meal before the test.
- Fast from food for 8–12 hours and from water for 1 hour before the procedure.
Factors That Affect Results
- Washings may be performed twice. Discarding the first aspirate and sending the second aspirate for study may be more reliable, especially for gastric neoplasms.
- Contamination of the specimen with food or barium invalidates the results.
- Reject specimens not packed in dry ice or not received promptly after collection.
- Reject slides that were allowed to dry before fixing or those received without fixative.
- Reject unlabeled slides.
- This is not as effective a diagnostic tool as radiography or endoscopy with biopsy.
- A negative report does not rule out malignancy.
- Gastroscopy-guided brushings are preferable to gastric washings for cytologic study.
- Proctosigmoidoscopic smears to investigate diarrhea should be performed with no preparation of the bowel because the exudate may be washed away, the mucosa distorted, trauma of the mucosa induced, or the evidence of disease obscured or altered.