Esophageal biopsies comprised 33 cases. Chronic regurgitation and heartburn were the chief complaints of the patients along with chest pain, dysphagia, vomiting, pain abdomen and consistent cough. Amongst the various lesions most common lesion was non-specific esophagitis with the least common being Barrett’s esophagus and hyperplastic polyp. (Table -1).All the malignant neoplastic lesions of esophagus were squamous cell carcinoma. The majority of squamous cell carcinoma was in the lower esophagus 10(71.43%) followed by the middle esophagus 3 (21.43%) and 1 case in the upper esophagus (7.14%). The majority of esophageal squamous cell carcinoma were moderately differentiated 10(71.43%) cases followed by 3 cases (21.43%) of well-differentiated squamous cell carcinoma and 1 case (7.14%) was poorly differentiated. The esophagus is the most common site for malignancy in the whole GIT.

Table 1: Distribution of Esophageal lesions

Endoscopic findings of esophageal lesions: Endoscopic features of esophagitis maximally included areas of hemorrhage and erosions/ulceration along with the areas of erythema and friability of the mucosa, hyperplastic polyp showed polyp and Barrett’s esophagus showed pink colon mucosa having tongue shape projections(figure-2). Squamous cell carcinoma of esophagus endoscopically presented with a different pattern of growth as ulcero-proliferative in maximum cases followed by ulcerated, ulcer infiltrative, stenosing/stricture and proliferative lesion

Gastric lesions: It comprised a total of 38 cases. The most common complaints were those of pain in the epigastrium, vomiting and pain abdomen along with dyspepsia, nausea, weight loss, faecal blood loss/ melena, and bloody vomitus. Chronic non-specific gastritis was the most commonly diagnosed lesion in 14 cases (36.84%) followed by 8 cases of chronic active gastritis with H. Pylori (21.06%), 3(7.89%) cases of Hyperplastic

This group comprised a total of 25 cases. The most common chief complaints in the pathologies of this region were pain abdomen, rectal bleeding, vomiting, diarrhea, fever, weight loss and faecal urgency. The most common complaint in the patient was pain abdomen. Patients who commonly complained of straining during defecation were diagnosed as the case of solitary rectal ulcer syndrome (SRUS). Children mostly presenting with rectal bleeding were diagnosed with a juvenile rectal polyp. The maximum number of cases were in the category of Chronic non-specific colitis 11(44%). (Table-2 ) . Adenocarcinoma was the most common malignant neoplastic lesion with 8 cases (40%). The majority of colorectal Adenocarcinoma were moderately differentiated by 5(62.50%) cases followed by 2(25%) cases of well-differentiated Adenocarcinoma and 1(12.50%) case was poorly differentiated.

Endoscopic findings of colorectal lesions:Majority of colitis presented as erythematous patch, erosion and ulceration on sigmoidoscopy and colonoscopy. On sigmoidoscopy, ulcerative colitis was characterized by erythematous and friable mucosa with mucosal granularity. Juvenile polyp showed polyp on endoscopy. Adenocarcinoma of the colon presented as ulcerative and ulceroproliferative growth on colonoscopy.

Figure 2: Barrett’s esophagus (H&E Stain- 40x), pink mucosa with tongue shape projections (Upper GI Endoscopy).

Figure 3: NHL Stomach (H&E Stain- 40x), Enlarged folds and diffuse thickening in fundus ( Upper GI Endoscopy)

Out of 100 cases, endoscopy revealed 46 (46%) neoplastic lesions, of which 35 (35%) cases were histologically diagnosed as neoplastic. On endoscopy 30 (30%) cases were inflammatory lesions whereas 44 (44%) cases were diagnosed as inflammatory on histopathology. On the other hand, 15 (15%) cases were revealed as an ulcerative lesion on endoscopy, of which 1case (1%) was a benign ulcer on histopathology. 6 (6%) cases were diagnosed as a polyp on both endoscopy and histopathology. 2 (2%) cases of Barrett’s esophagus on endoscopy, both cases were histologically diagnosed as Barrett’sesophagus. On endoscopy 1 (1%) case was of the heterotopic pancreas, it was diagnosed as heterotopic pancreas histologically. Moreover, 9 (9%) cases were diagnosed as dysplasia with mild hyperplasia on histopathology (Table-3). In the present study, we included dysplastic squamous epithelium of the esophagus and adenoma of the stomach in the non-neoplastic category because no obvious malignancy was found in the histopathology of those lesions. Endoscopy finding inflammatory lesions included erythema, erosion, scalloping or loss of fold, friable mucosa and mucosal granularity.

Among 100 cases, endoscopy reported 46(46%) cases as neoplastic and 54(54%) as non-neoplastic, whereas Histopathology revealed 35(35%) as neoplastic and 65 (65%) as non-neoplastic. All neoplastic lesions are malignant (100%). The correlation of endoscopic and histopathological findings in neoplastic lesions revealed a sensitivity and specificity of 100% and 83.08% respectively with a positive predictive value of 76.09%. The chi-square statics is 20.4017. The p-value =<0.000416, which is statistically significant. The result is significant at p<0.01.

P et al [11]. In contrast, Bilal A sheikh et al [12]. in his study, observed that poorly differentiated adenocarcinoma was more common than moderately differentiated adenocarcinoma. Antrum was the most commonest site of gastric carcinoma followed by the body of the stomach. A study byAbilash SC et al [8]. also showed similar results. On endoscopy; the majority of cases of gastritis showed erosion and hemorrhage in superficial mucosa, along with erythema and mucosal irregularities similar to the study done by Kaur M et al [13]. In our study, adenocarcinoma of the stomach endoscopically presented as ulcerative growth (40%), followed by ulceroproliferative growth (30%) proliferative growth (20%), flattening of mucosa and erythematous appearance (5% each), which is similar to study done by Krishnappa R et al [2].

Duodenal lesions: In the present study, only 4 duodenal biopsies were received, out of which 1 showed chronic non-specific duodenitis and 1 case of celiac sprue. Two cases were reported of adenocarcinoma, both were well-differentiated adenocarcinoma of the ampulla of Vater, which is similar to a study done by Krishnappa R et al [2]. In endoscopy, the loss of scalloping or folds of the mucosa is the commonest finding to diagnose celiac disease similar to a study done by Kaur M et al[13].

Colonic Lesions: Among the lower gastrointestinal biopsies, colonic biopsies were the most common. 25 colorectal biopsies were received. The most common lesion in the colonic biopsies in the present study was chronic non-specific colitis (44%). Among the malignancies of the colon, moderately differentiated adenocarcinoma was the most common constituting 80% of colonic malignancies, which is similar to the study by Durrani A[14].On sigmoidoscopy, the erythematous and granular mucosa is the commonest findings to diagnose ulcerative colitis similar findings were found study done by Kaur M et al [13].

Among 100 cases endoscopy reported 46(46%) cases as neoplastic and 54(54%) as non-neoplastic, whereas Histopathology revealed 35(35%) as neoplastic and 65 (65%) as non-neoplastic. All neoplastic lesions       were malignant(100%), which is higher than the study done by Islam et al (46.36%) [4]. and Nazrin et al (55.56%)[15]. Endoscopy and biopsy have certain advantages and limitations. Advantages: It is a minimally