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Updated: Jul 12, 2026
04:09
The Pocket-Creation Procedure of Endoscopic Submucosal Dissection for Large Rectal Laterally Spreading Tumors
Published on: February 13, 2026
Risk-based pathology reporting after endoscopic submucosal dissection for early gastrointestinal cancer:
Kareem Khalaf1, Huaqi Li1, Mai Iwaya2
1Division of Gastroenterology, St Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada.
Gut
|July 10, 2026
Summary
New international pathology standards for endoscopic submucosal dissection (ESD) specimens standardize reporting of early gastrointestinal cancers. These guidelines improve accuracy in assessing invasion depth, margins, and histological features for better treatment decisions.
Area of Science:
- Gastroenterology and Pathology
- Oncology
- Surgical Pathology
Background:
- Endoscopic submucosal dissection (ESD) is crucial for early gastrointestinal cancer resection, yielding specimens for risk assessment.
- Current pathology reporting for ESD specimens lacks standardization, impacting curative resection assessment and treatment planning.
- Key parameters like invasion depth, margin status, and histological features are inconsistently reported.
Purpose of the Study:
- To establish practical international standards for pathology assessment and reporting of invasive carcinoma in ESD specimens.
- To create consensus-based guidelines for consistent and accurate pathological evaluation of ESD resections.
Main Methods:
- A modified Delphi consensus process involving 42 international experts (28 gastrointestinal pathologists, 14 endoscopists) from 15 countries.
- Statements covered invasion measurement, margin assessment, staining protocols, specimen handling, prognostic features, and reporting.
Main Results:
- 56 consensus recommendations were achieved across seven domains.
- Standardized methods for reporting submucosal invasion depth (micrometres) and breadth (millimetres).
- Defined margin positivity, recommended baseline H&E staining with selective ancillary stains, and integrated prognostic features into composite risk assessment.
Conclusions:
- The developed consensus standards offer immediately implementable, synoptic reporting criteria for ESD pathology.
- Standardization aims to reduce interinstitutional variability and enhance multidisciplinary decision-making.
- These guidelines will support future validation of risk models for early gastrointestinal cancer.
