Abstract
Aims Reliable histological confirmation of colorectal cancer is essential for staging and treatment planning. Conventional forceps biopsy (FB) often provides specimens that are too small or too superficial. This study examined whether a novel endoscopic cryobiopsy (CB) technique improves diagnostic adequacy. Methods In this prospective study, fresh surgical colorectal cancer specimens larger than 2 cm were longitudinally opened and sampled before fixation. Sampling was performed by an endoscopist directly on the intact mucosal surface.Two FB samples were obtained using disposable oval-spoon forceps (Ø 2.3 mm, 180 mm, [Radial Jaw 4, large capacity, Boston Scientific, Marlborough, USA]). Four CB samples were obtained using a flexible 1.7-mmCB probe (length 115 mm) powered by the ERBECRYO 2 console (Erbe Elektromedizin GmbH, Tübingen, Germany). The probe tip was placed on the target tissue, freezing was activated via foot pedal, and the sample was released by rapid traction at predefined freezing times of 1, 2, 3, and 4 seconds (CB1-4). Healthy mucosa was sampled before tumor tissue to avoid contamination.Primary endpoint was specimen length. Secondary endpoints included perforation, deepest histological layer reached in healthy tissue, tumor histology classification, and biopsy quality rated on a 0–3 Likert scale. Results Across six specimens, 48 CB samples and 24 FB samples were collected. Mean specimen length was 3.63 mm±1.25 for FB; 3.33±0.89 for CB1; 4.00±0.95 for CB2; 5.17±0.84 for CB3; and 4.75±1.60 mm for CB4 (p<0.001).Depth analysis of healthy mucosa showed that FB reached lamina propria in 67 percent and lamina muscularis mucosae in 33 percent. CB reached deeper layers more consistently. Submucosa was attained in 50 percent of CB1, 83 percent of CB2, 83 percent of CB3, and 50 percent of CB4 samples; one CB4 sample reached superficial muscularis propria (p=0.013). No perforations were observed. Tumor biopsies revealed high-grade dysplasia (HGD) in 75 percent of FB samples and HGD suggestive of invasive cancer (HGD-SIC) in 25 percent. CB provided comparable or improved diagnostic granularity. CB3 identified one definitive adenocarcinoma, which was not detected by FB. Biopsy quality (Likert>1) was achieved in 63 percent of FB samples, 92 percent of CB1 and CB2 samples, 100 percent of CB3 samples, and 92 percent of CB4 samples (p=0.032). Conclusions This novel cryobiopsy technique, using a flexible 1.7-mm probe, consistently produced larger, deeper, and higher-quality tissue specimens than standard forceps biopsy. A freezing time of 3 seconds offered the most favorable balance of size, depth, and diagnostic yield. Cryobiopsy may provide a meaningful diagnostic advantage in colorectal lesions where depth of invasion remains uncertain and could support more precise therapeutic decision-making. Publication History Article published online: 05 June 2026 © 2026. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
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