INTRO: Large esophageal biopsies are difficult to obtain because the endoscope is parallel to the mucosa. Suction biopsies using a capsule produce large samples. We hypothesized that using a friction-fit adaptor to suction esophageal mucosa while simultaneously performing pinch biopsy would result in larger and deeper specimens. METHODS: Esophageal biopsies were obtained in 12 pts. undergoing diagnostic EGD using Olympus GIF-130 endoscope (2.8 mm channel). The mucosa was endoscopically abnormal in all patients. Equal numbers of pinch biopsies were obtained from the distal esophagus at similar levels with and without suction technique in all subjects using standard biopsy forceps (2.2 mm). After performing standard pinch biopsies, the scope was removed and BARD friction-fit adaptor was mounted on the endoscope tip. The scope was reintroduced without the use of an overtube. While the mucosa was suctioned into the adaptor, pinch biopsy was performed. An experienced GI pathologist, blinded to biopsy method, evaluated the tissue for subjective quantity and quality, histologic diagnosis, depth of biopsy, and measured surface area (micrometer units) per biopsy. No complications occurred. RESULTS: Of 12 pts., the subjective evaluation of the quantity and quality of the histologic material was superior with suction-pinch in 10; in 4 pts. the diagnosis was more definitive using suction-pinch. Smooth muscle was present in 4/33 suction-pinch biopsies and 0/33 pinch biopsies. SUCTION-PINCH PINCH p (+) Histologic Diagnosis 12/12 10/12 NS Submucosa or deeper (number of biopsies) 20/33 6/33 <0.01*Surface area per Biopsy (Mean ± SEM) 5530.0 ± 660 4003.6 ± 566 < 0.01***using Fischer's exact test;**using paired student's t-test CONCLUSIONS: 1) Combined suction-pinch esophageal biopsy technique produces a larger volume of tissue per biopsy with greater depth than standard pinch biopsy technique 2) This new technique had no complications and may improve diagnostic yield of esophageal biopsy specimens 3) Studies are needed to determine if the suction-pinch biopsy technique using standard biopsy forceps will produce biopsy specimens as large as those obtainable with standard pinch technique and jumbo biopsy forceps (which requires a 3.2 mm biopsy channel).