Introduction

The Human Gastrointestinal (GI) tract is a common site for various lesions, including congenital, inflammatory, and neoplastic conditions. These lesions contribute significantly to morbidity and mortality.[1]

To diagnose GI diseases, investigative methods such as endoscopy, colonoscopy, cytopathology, gastric secretory function and absorption of vitamin B12, etc., are comfortably used. However, all of the above have some shortcomings and limitations.[2]

The introduction of endoscopes in the 1960s has greatly improved the diagnostic facility for fiberoptic endoscopy because they are readily accessible and can easily be sampled for specific histopathological or microbiologic investigation with available biopsy forceps.[3] It is a diagnostic procedure used to visualize the oropharynx, esophagus, stomach, and proximal duodenum.[4] Gastric symptoms like dyspepsia, vomiting, abdominal pain, ulcers, etc, are very common causes of discomfort amongst patients & are the common reasons for referral for endoscopic examination. GIT endoscopy, along with biopsy, is not only used to diagnose malignant and inflammatory lesions but is also used for monitoring the course, extent of the disease, response to the therapy and early detection of complications.[5] Colonoscopy is a diagnostic as well as a therapeutic procedure performed to evaluate the large intestine (i.e., colon, rectum, and anus) as well as the distal portion of the small intestine (terminal ileum).[6]

The aim and objectives of this study are to assess the diagnostic correlation between endoscopic impressions and histopathological diagnosis, and to determine the accuracy of endoscopy in detecting various upper and lower GI tract pathologies.

Materials and Methods

This was a retrospective study conducted from March 2024 to April 2024. The study was conducted among 200 cases who underwent upper gastrointestinal endoscopy(125) or colonoscopy(75) at Sri Balaji Institute of Medical Sciences(SBIMS), Raipur, Chhattisgarh. All endoscopic and colonoscopic biopsies of the upper and lower GI tract were included in the study, and biopsies were taken from abnormal or suspicious lesions. Biopsy was done for therapeutic purposes,

Table 1: Age and Sex Distribution of Endoscopy Patients

Table 2: Age and Sex Distribution of Colonoscopy Patients

Maximum number of upper GI patients presented with abdominal pain(65%), regurgitation(25%), vomiting(10%), dyspepsia(10%). Most of the colonoscopy patients presented with altered bowel habits(68%), abdominal pain(45%), blood in stools(15%), weight loss(10%).

Table 3: Correlation in Upper GI Endoscopy

Out of 125 upper GI cases, 115 endoscopy reports correlated with histopathology reports. Concordance Rate was 92%. (Table 3) In 10 cases, endoscopy reports didn’t correlate with histopathology reports. (Table 4)

Table 4: Discordance in endoscopy and histopathology reports

Figure 3: Microscopic image of Infective Colitis

Table 6: Discordance in Colonoscopy and Histopathology Reports

Discussion

The GIT presents a spectrum of disorders ranging from benign inflammatory conditions to malignant neoplasms, with dyspepsia and GERD being common indications for upper GIT endoscopy. Dyspepsia, characterised by upper abdominal pain or discomfort, can signify various underlying issues such as peptic ulcer disease, gastritis, or gastric cancer.

In contrast, GERD involves reflux of stomach acid into the oesophagus, leading to symptoms such as heartburn and regurgitation, potentially progressing to Barrett’s oesophagus and increasing the risk of oesophageal adenocarcinoma. Endoscopic techniques play a crucial role in diagnosing and managing these conditions, aiding the early detection of malignancies and guiding appropriate patient management.[7]

The modern endoscope has evolved from a rigid hollow metal tube to a light, flexible fibreoptic system using self-illumination. It not only allows visual inspection of the GI tract, but also permits access to the suspected tissue area with the aid of a biopsy needle. Endoscopic biopsy is an easy, minimally invasive & cost-effective procedure when it comes to arriving at a specific diagnosis of a patient with non-specific symptoms. Expertise on the part of endoscopists in choosing the appropriate site is therefore needed,

In the present study, endoscopy and histopathology reports were concordant in 92% and 90.6% in upper and lower GI lesions, respectively, which is very high and similar to the studies done by Mishra et al[10], Islam et al[12] and Krishnappa et al[13].

10(8%) upper GI cases and 7(9.6%) lower GI cases were discordant. These discrepancies highlight the importance of considering the various factors, such as histologic heterogeneity, limitations in human interpretation. The data presented in the tables and supported by previous studies demonstrate a high concordance between endoscopic and histological diagnoses in the oesophagus, stomach, duodenum and colon, indicating the reliability of endoscopic procedures in diagnosing gastrointestinal lesions. Variability in concordance rates highlights the need for histopathological confirmation to ensure diagnostic accuracy and appropriate treatment.

Conclusion

The upper GI endoscopy and colonoscopy are the diagnostic tools of choice to detect upper and lower GI diseases. Gross visualisation through endoscopy and colonoscopy cannot always detect the mucosal lesions, whether it is benign or malignant; histopathologic examination can provide an accurate diagnosis. This study provides critical insights into the diagnostic concordance between endoscopic and histopathological findings in patients with upper and lower GIT lesions. Although endoscopy and colonoscopy are the primary diagnostic tools for GIT pathologies, our findings highlight the importance of histopathological confirmation to ensure diagnostic accuracy.

Permission from the Institutional Research Board: Yes

Funding: Nil

Conflict of interest: None Initiated

References