Exfoliative cytology of the gastrointestinal (GI) tract is useful in the diagnosis of benign and malignant diseases. It is not, however, a specific test for these diseases. Many benign diseases, such as leukoplakia of the esophagus, esophagitis, gastritis, pernicious anemia, and granulomatous diseases, may be recognized because of their characteristic cellular changes. Response to radiation may also be noted from cytologic studies.

1. Administer a sedative before the procedure. For esophageal studies, pass a single-lumen nasogastric (NG) ~40 cm (to the gastroesophageal junction) with the patient in a sitting position.

2. For stomach studies, pass a single-lumen NG tube into the stomach (~60 cm) with the patient in a sitting position.

3. For pancreatic and gallbladder drainage, pass a double-lumen gastric tube orally 45 cm, with the patient in a sitting position. Then, place the patient on the right side and pass the tube slowly 8.5 cm. It takes about 20 minutes for the tube to reach this distance. Confirm the tube location by biopsy. Lavage with physiologic salt solution is done during all upper GI cytology procedures.

4. Be aware that specimens can also be obtained during endoscopy procedures.

5. Material obtained during endoscopy with the use of brushes may be smeared directly on glass slides, which are fixed immediately in 95% alcohol or spray fixative. Brushes may also be placed in a fixative such as 50% alcohol. See Chapter 12 for endoscopic biopsy procedures. Washings must be delivered immediately to the laboratory and may need to be placed on ice. Check with your individual laboratory for specific instructions on handling of washings from the GI tract.

1. The characteristics of benign and malignant cells of the GI tract are the same as for cells of the rest of the body.

2. Abnormal results in cytologic studies of the esophagus may be a nonspecific aid in the diagnosis of:

   1. Acute esophagitis, characterized by increased exfoliation of basal cells with inflammatory cells and polymorphonuclear leukocytes in the cytoplasm of the benign squamous cells

   2. Vitamin B₁₂ and folic acid deficiencies, characterized by giant epithelial cells

   3. Malignant diseases, characterized by typical cells of esophageal malignancy

3. Abnormal results in studies of the stomach may be a nonspecific aid in the diagnosis of:

   1. Pernicious anemia, characterized by giant epithelial cells. An injection of vitamin B₁₂ causes these cells to disappear within 24 hours.

   2. Granulomatous inflammations seen in chronic gastritis and sarcoidosis of the stomach, which is characterized by granulomatous cells.

   3. Gastritis, characterized by degenerative changes and an increase in the exfoliation of clusters of surface epithelial cells.

   4. Malignant diseases, most of which are gastric adenocarcinomas. Lymphoma cells can be differentiated from adenocarcinoma. The Reed–Sternberg cell, a multinucleated giant cell, is the characteristic cell found along with abnormal lymphocytes in Hodgkin disease.

4. Abnormal results in studies of the pancreas, gallbladder, and duodenum may reveal malignant cells (usually adenocarcinoma), but it is sometimes difficult to determine the exact site of the tumor.

5. Abnormal results in examination of the colon may reveal:

   1. Ileitis, characterized by large, multinucleated histiocytes

   2. Ulcerative colitis, characterized by hyperchromatic nuclei surrounded by a thin cytoplasmic rim

   3. Malignant cells (usually adenocarcinoma)

Pretest Patient Care

1. Tell the patient the purpose of this test, the nature of the procedure, and to anticipate some discomfort.

2. Explain that a liquid diet usually is ordered for the 24 hours before testing. Encourage the patient to take fluids throughout the night and in the morning before the procedure.

3. Do not administer oral barium for the preceding 24 hours.

4. Tell the patient that laxatives and enemas are ordered for colon cytologic studies.

5. Because insertion of the NG tube can cause considerable discomfort, devise a system (e.g., raising a hand) with the patient to indicate discomfort. (See gastric analysis procedure in Chapter 16.)

6. Inform the patient that panting, mouth breathing, or swallowing can help to ease insertion of the tube.

7. Tell the patient that sucking on ice chips or sipping through a straw also makes insertion of the tube easier.

8. Explain that ballottement and massage of the abdomen are needed to release cells when a gastric wash technique is used.

9. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

The lubricant used to insert NG tubes can interfere with results because it may distort the cells and prevent accurate evaluation.

Normal

Negative for abnormal cells

Squamous epithelial cells of the esophagus may be present.