Gastrointestinal neuromuscular diseases (GINMD) are relatively rare but severe disorders manifest commonly as impaired motor activity and slowed or obstructed transit with or without visceral dilatation.1 Primary diagnoses include enteric dysmotility, intestinal pseudo-obstruction and slow-transit constipation. These conditions result in considerable individual morbidity and mortality including intestinal failure and suicide.2

Although surgery is best avoided for most patients with GINMD2 resection or biopsy is sometimes an “end-of-line” procedure for symptom relief or diagnosis. Tissues derived include colectomy specimens from patients with slow transit constipation, and full thickness or seromuscular bowel biopsies are now increasingly performed laparoscopically3 4 Other biopsies may be taken at laparotomy or stoma formation. Information regarding underlying GI neuromuscular pathology is of value to allow better certainty of diagnosis to facilitate discussion regarding the disorder and prognosis, to give patients a more objective correlate for their condition and occasionally guide therapy. Implicit is the assumption that findings are accurate. Anecdotal evidence suggests a great deal of variation in techniques …