Digestive pathology represents an essential part of the activity of most pathologists. Over the past decade, developments and advances have changed the endoscopic technique approach for digestive pathologies.

In addition to laparoscopic surgery for advanced and large cancers, polypectomy and new endoscopic techniques such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have allowed for the resection of superficial lesions. The management and handling of specimens is very important to obtain optimal and precise histopathological evaluation of lesions in order to determine whether additional therapy is necessary or not.

These endoscopic techniques may be used, and particularly for the treatment of premalignant and early stage malignant lesions of the digestive tract, affecting the esophagus (dysplasia and epidermoid carcinoma), the stomach, Barrett’s mucosa, as well as the colon or the rectum (dysplasia and adenocarcinoma). This presentation outlines the different steps to appropriately handle these specimens (i.e., orientation, fixation, dissection, embedding and histological process).

The pathological examination should be precise and based on currently recommended classifications of flat and polypoid preneoplastic or early carcinomatous lesions. The histopathological report should include quality of resection as well as prognostic parameters in order to evaluate the risk of lymph node metastasis and the need for a complementary treatment. Among these parameters, evaluation of invasion, and particularly submucosal invasion, are significant.

Finally, specific problems related to pathological evaluation shall be emphasized.