Histopathological Study of Upper Gastrointestinal Tract Endoscopic Biopsies in a Teaching Hospital

: Background: When a patient has an upper gastrointestinal disorder-which frequently manifests as dyspepsia-upper gastrointestinal endoscopy is considered the preferred diagnostic procedure. Without a biopsy, endoscopy cannot be considered complete, and the most reliable method for diagnosing lesions seen during endoscopy is histopathology. Methodology: This retrospective study was conducted in the Department of Pathology at A.C.S Medical College and Hospital for one year duration from July 2022 to July 2023. A total of fifty-five endoscopic biopsy specimens were obtained; they were preserved in 10% formalin and regularly stained with hematoxylin and eosin. Results: The majority was found to be 45.4% (25/40) of those aged 61-70, 36.3% (20/55) of those aged 51-60, and 18.1% (10/55) of those aged 40-50.Thirty patients (18.7%) had duodenal lesions, 80 cases (50%) had stomach lesions, and 50 cases (31.2%) had oesophageal lesions. Most upper gastrointestinal tract endoscopic biopsies came from the stomach. Conclusion: Endoscopy is insufficient without biopsy, and the gold standard for diagnosing lesions seen during an endoscopy is histopathology. The particular location of mucosal lesions can be seen with the use of upper gastrointestinal tract endoscopy. Therefore, we may draw the conclusion that using these two approaches together offers a potent diagnostic tool for improved patient care.


I. INTRODUCTION
Gastrointestinal illnesses constitute a significant burden in clinical practice, contributing to both morbidity and mortality [1].Specimens obtained from the mucosa of the esophagus, stomach, and duodenum play a crucial role in diagnostic procedures.In the realm of surgery, endoscopy-guided biopsies are the recommended method, providing essential information for diagnosis and subsequent treatment decisions [2].Histopathological diagnosis becomes particularly critical in cases involving polypoid lesions, ulcerative lesions, and ambiguous findings during endoscopy.Combined with biopsy, upper gastrointestinal (GI) endoscopy is indispensable for the early detection of GI neoplasms, offering various therapeutic options, including potential curative interventions [3].The development of an appropriate treatment plan relies, in part, on histological confirmation of the final diagnosis of gastrointestinal lesions.
The esophagus and stomach are susceptible to a diverse range of conditions, including infections, inflammatory disorders, vascular issues, mechanical problems, and chemical or physical reactions, such as radiation damage and neoplasms [4].The current gold standard for evaluating individuals presenting with gastrointestinal symptoms involves endoscopic biopsy examination, a generally safe procedure followed by histopathologic assessment [5].
This study aims to characterize the spectrum of histopathological lesions affecting the gastrointestinal tract.

II. MATERIALS AND METHODS
This cross-sectional study was conducted in the Department of Pathology at A.C.S Medical College and Hospital over one year, from July 2022 to July 2023.The study included 55 individuals with gastrointestinal complaints who underwent endoscopic biopsies for diagnostic purposes.

INCLUSION CRITERIA
• Endoscopic biopsies from the stomach, duodenum, and esophagus in both male and female patients of all ages.

EXCLUSION CRITERIA
• Individuals with a history of prior treatment for gastrointestinal tract cancer.• Pharyngeal and oral cavity biopsies.

III. METHODOLOGY
Upon receipt in appropriately labeled, securely sealed containers with 10% formalin, the biopsies underwent a thorough examination to assess their quantity and appearance.Following sufficient fixation, the entire sample underwent standard processing before being embedded in paraffin, with the mucosal surface positioned on top.Sections, five microns thick, were cut perpendicular to this surface using a rotating microtome, resulting in the preparation of three to four serial sections per slide.Sections were mounted with cover slips using Distyrene Plasticizer Xylene (DPX) as the mountant after being stained with Hematoxylin and Eosin.Special stains, such as Gomori's methenamine silver (GMS) and periodic-Schiff (PAS) stains for fungi, the reticulin stain for assessing the degree of atrophy in the stomach mucosa, and the Giemsa stain for identifying organisms like Helicobacter pylori, were used when necessary.

IV. STATISTICAL ANALYSIS
The collected data were compiled in a master chart, and analysis and computations were performed as required.Quantitative and qualitative variables were represented as percentages.
The majority of patients in the third decade underwent esophageal and stomach biopsies, with a higher frequency of biopsies from both sites in males than in females.In the fourth decade, duodenal biopsies were performed on patients most frequently, with men predominating over women in this setting as well.
The distribution of biopsy sites in the oesophagus was as follows: middle esophagus (20%), upper esophagus (14%), and lower end of the esophagus (66.6%).The majority of esophageal biopsies were taken from individuals in their sixth decade (35%) and seventh decade (10%), with a male-tofemale ratio (M:F) of 2:1 (Table 2).
In our study, it was observed that a majority of the patients, constituting eighty percent (8/10), exhibited chronic duodenitis, whereas a smaller proportion, specifically two percent (2/10), presented with H. pylori-associated duodenitis.Notably, in the fourth decade, duodenal biopsies were most frequently conducted, and a notable male predominance  over females was evident in this demographic context.

VI. DISCUSSION
The upper gastrointestinal system is a frequent site for various abnormalities, particularly malignant tumors.Globally, esophageal carcinoma ranks as the sixth leading cause of death, and stomach carcinoma is the second most common type of cancer.Early cancer detection significantly enhances patients' chances of survival, and upper GI endoscopy, coupled with biopsy, is the most precise and sensitive diagnostic technique for identifying gastric, duodenal, and esophageal cancers [6].

COMPARATIVE STUDIES RELATED TO AGE DISTRIBUTION
In

COMPARATIVE STUDIES RELATED TO CLINICAL SYMPTOMS
In our study, dysphagia, vomiting, and abdominal pain were the most common clinical symptoms.Similar findings were reported by Nazrin et al. [7].In the study by Mathew et al. [8], dysphagia was the most prevalent symptom, followed by nausea, stomach discomfort, vomiting, dyspepsia, lack of appetite, and weight loss.

COMPARATIVE STUDIES RELATED TO ESOPHAGEAL LESIONS
In our study, 33.3% (5/15) of esophageal biopsies were neoplastic, while 66.6% (10/15) were non-neoplastic.Among the non-neoplastic lesions, 53.3% (8/15) were persistent nonspecific esophagitis.Neoplastic lesions included two cases (13.3%) of squamous cell carcinoma and one case each of high-grade dysplasia and adenocarcinoma.In Nazrin et al.'s study [7], out of 53 esophageal biopsies, 84.92% had neoplastic lesions, with 73.60% being squamous cell carcinoma and 11.32% adenocarcinomas.Mathew et al. [8] reported that neoplastic lesions (69.20%) were more common in the esophagus than non-neoplastic lesions (30.80%).The majority of non-neoplastic lesions were due to reflux esophagitis.Sahu et al.'s study [9] observed instances of reflux esophagitis and Barrett's esophagus among esophageal biopsies, with adenocarcinomas being present.Rani et al.'s study [10] revealed that 93.3% of esophageal biopsies were neoplastic, with various types of squamous cell carcinoma being predominant.

VII. CONCLUSION
Histopathology is the gold standard for the diagnosis of endoscopically detected lesions and endoscopy is incomplete without biopsy.The particular location of mucosal lesions can be seen with the use of upper gastrointestinal tract endoscopy.Therefore, we may draw the conclusion that using these two approaches together offers a potent diagnostic tool for improved patient care.

TABLE 1 :
Distribution of Esophageal Lesions

TABLE 2 :
Distribution of Gastric Lesions