Pathological Discrepancies Between Endoscopic Forceps Biopsy and Endoscopic Resection Specimens in Gastrointestinal Mucosal Lesions: A Meta-analysis and Systematic Review

Background and Aims:Endoscopic forceps biopsy and endoscopic resection are critical techniques in the diagnosis of gastrointestinal lesions.However,pathological discrepancies between biopsy and resection specimens have been reported,potentially impacting clinical outcomes.Methods:A comprehensive search of electronic databases was performed to identify clinical trials comparing pathological discrepancy between endoscopic forceps biopsy and resection specimens for gastrointestinal lesions.Systematic review registration PROSPERO,CRD42024582538.Results:This analysis enrolled 38 studies,including 10329 patients.The pooled pathological discrepancy rate,pathological upgrade rate,and pathological downgrade rate were 0.30(95% CI: 0.25-0.34),0.25(95% CI:0.21-0.29),and 0.02(95% CI:0.02-0.03),respectively,with significant heterogeneity(I2>93.9%; p<0.001).Conclusion:This meta-analysis highlights significant pathological discrepancies between endoscopic biopsy and endoscopic resection specimens,with a predominant risk of pathological upgrading indicating that biopsy frequently underestimates disease severity, particularly in the evaluation of HGD.Conversely,downgrading risks were low but necessitate caution against overtreatment.Non-neoplastic lesions showed the lowest diagnostic accuracy,while cancer diagnosis was highly reliable.