A Novel Endoscopic Biopsy Technique for Translational Research in Patients with Inflammatory Bowel Disease

Introduction: Standard forceps biopsies often provide insufficient cellular yield for single-cell and spatial transcriptomic analyses. We assessed the feasibility of cold-snare resection in inflammatory bowel disease (IBD) and compared immune cell composition with standard forceps biopsies. Methods: Patients with active IBD at endoscopy were included. One cold-snare resection and two standard biopsies were obtained from inflamed mucosa in the ileum, colon or rectum. Sample quality and cell yield were evaluated using histology staining and flow cytometry. Adverse events (AEs) were recorded peri-procedurally, at a 7-day follow-up, and up to 30 days. Results: Thirty-four patients with IBD were included. Cold-snare resection was successful in all cases and yielded significantly higher number of T-cells (median 71×10 3 vs. 17×10 3 , p=0.016) and rare innate lymphoid cells (median 576 vs. 127, p=0.016) compared with standard forceps biopsies. Four mild AEs were reported. Conclusion: Cold-snare resection improves mucosal tissue integrity and cellular quality compared with standard biopsies, supporting its use for translational studies in IBD.