Techniques in Coloproctology

, Volume 22, Issue 11, pp 857–866 | Cite as

Optimal processing of ESD specimens to avoid pathological artifacts

  • L. Reggiani BonettiEmail author
  • R. Manta
  • M. Manno
  • R. Conigliaro
  • G. Missale
  • G. Bassotti
  • V. Villanacci
Original Article



En bloc endoscopic submucosal dissection (ESD) has been recently introduced as a treatment for precancerous/neoplastic gastrointestinal conditions. The aim of the present study was histological assessment of en bloc ESD specimens.


Fifty-three ESD specimens were positioned over a cellulose acetate support (40 specimens; 12 from the upper gastrointestinal tract and 28 from the lower gastrointestinal tract) or pinned with nails on polystyrene or cork (13 specimens; 7 from the upper gastrointestinal tract and 6 from the lower gastrointestinal tract). We cut consecutive 2 mm-thick sections stained with hematoxylin and eosin. From the first and the last sections, we obtained a second slide, after a 180° rotation and re-embedding. The quality of ESD samples was scored as inadequate, suboptimal and adequate, based on the amount of crushing, shearing and stretching artifacts that were scored from 0 (absent) to 2 (diffuse or maximum). From the sum of these we obtained a global artifact score (GAS).


Removed lesions were: adenocarcinoma (5 cases), neuroendocrine tumor (NET) G1 (1 case), premalignant conditions, including adenomatous polyps (41 cases) and hyperplastic lesions (6 cases). A positive deep surgical margin was found in 8/53 cases (15%): high- and low-grade dysplastic glands were detected in 5 cases, low-grade adenocarcinoma in 2, and NET cells in 1. Dysplastic glands were detected in the lateral surgical margins of 12 ESD specimens (23%). Among the ESD specimens positioned on the cellulose acetate support, apart from the modifications due to electrocoagulation, 2 (5%) showed shearing modifications. In the group of ESD specimens fixed with nails, 5 (38%) showed shearing, 10 (77%) crushing artifacts, 11 (85%) stretching and 11 (85%) multiple holes caused by the nails. On the basis of these data all histological specimens from ESD on cellulose acetate were adequate (GAS 0–1).However, in the group of ESD fixed with nails, 1 was adequate (GAS 0), 11 suboptimal (GAS 2–5) and 1 inadequate (GAS 6).


Specific devices including cellulose support and adequate sampling blocks can be helpful to perform accurate histological assessment of ESD specimens after en bloc ESD for precancerous/neoplastic gastrointestinal lesions, with complete analysis of the status of the margins and the entirely en bloc evaluation of the lesion.


Endoscopic submucosal dissection Histological assessment Crushing artifacts Stretching artifacts Holes Cellulose acetate 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this retrospective study, no ethical approvation was required at the moment of the study design.

Informed consent

No personal data of the patients are mentioned; no further diagnostic insigths were tested; no changes in original diagnosis have been producted.


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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • L. Reggiani Bonetti
    • 1
    • 7
    Email author
  • R. Manta
    • 2
  • M. Manno
    • 3
  • R. Conigliaro
    • 2
  • G. Missale
    • 4
  • G. Bassotti
    • 5
  • V. Villanacci
    • 6
  1. 1.Institute of Pathology of Modena Az.Ospedaliero-Universitaria Policlinico di ModenaModenaItaly
  2. 2.Endoscopy Unit Ospedale Baggiovara, (NOCSAE)BaggiovaraItaly
  3. 3.Digestive Endoscopy UnitCarpi HospitalModenaItaly
  4. 4.Endoscopy Unit Spedali CiviliBresciaItaly
  5. 5.Gastroenterology and Hepatology Section, Department of MedicineUniversity of Perugia School of MedicinePerugiaItaly
  6. 6.Institute of Pathology Spedali CiviliBresciaItaly
  7. 7.Department of Diagnostic Medicine and Public HealthUniversity of Modena and Reggio Emilia Section of PathologyModenaItaly

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