Clinico-pathological findings in a series of gastrointestinal endoscopic submucosal dissection specimens: A...

Endoscopic submucosal dissection (ESD) enables en-bloc resection of superficial gastrointestinal lesions, offering curative treatment while preserving organ function. This study aimed to characterize the clinico-pathological spectrum of gastrointestinal ESD specimens at a tertiary care centre over five years and identify factors influencing patient management. All ESD specimens received from January 2020 to December 2024 were retrospectively reviewed, with grossing performed according to International Collaboration on Cancer Reporting (ICCR) guidelines. Histological evaluation included lesion type, depth of invasion, margin status, lymphovascular and perineural invasion, and tumour budding, with follow-up obtained from electronic medical records. Seventy-two specimens were analyzed (mean age 68 years; M:F = 1.5:1), with lesion sites comprising stomach (32 %), esophagus (21 %), rectum (21 %), sigmoid colon (18 %), and duodenum (8 %). Epithelial lesions constituted 69 % (50/72), of which malignant epithelial tumours formed 24 % (17/72), including esophageal squamous cell carcinomas (n = 4), esophageal adenocarcinoma (n = 1), gastric adenocarcinomas (n = 4), and colorectal adenocarcinomas (n = 8). En-bloc resection was achieved in 93 % overall and 88 % of malignant specimens. After excluding two indeterminate cases, R0 resection was achieved in 60 % (9/15) of malignant tumours, enabling accurate margin assessment and staging. Additional surgical intervention was required in 29.4 % (5/17) malignant cases due to margin positivity, with one specimen showing further high-risk features. No patients received neoadjuvant therapy. Residual tumour and lymph node metastasis were identified in three and one malignant specimens, respectively. The use of standardized grossing and reporting protocols facilitated accurate pathological risk stratification and guided subsequent clinical decision-making.