Background Stomach is a common site for wide variety of lesions. The visualisation of the site with endoscopy and its biopsy leads to the early detection of the pathological process and appropriate therapy. Objectives The objective of this study is to correlate the histopathological pattern of endoscopic biopsies with distribution of gastric lesions according to age and sex. Method The study was carried out among 100 cases with endoscopic biopsies and histological assessment, received at Department of pathology, Rajendra Institute of Medical Science, Ranchi. Result Out of 100 cases majority of cases were male gender with male : female ratio was 2.1:1. Our study showed a poor correlation between endoscopic and histopathologic evidence of inflammation of the stomach. Five cases were diagnosed as intestinal metaplasia which were diagnosed as intestinal metaplasia which were diagnosed endoscopically as ulcer and erosion. Out of 34 of cases diagnosed endoscopically as ulcer , only 4 cases were confirmed histologically. Our study showed good correlation in the cases of carcinoma. Out of 32 cases diagnosed endoscopically as gastric carcinoma correlated histologically as gastric adenocarcinoma. Majority of carcinoma cases showed ulcerating fungating growth followed by ulcero–proliferative growth. Conclusion Endoscopy is incomplete without biopsy and histopathology. Histopathology is the gold standard for the diagnosis of endoscopically detected lesions. Endoscopic examination and histopathological examination of suspected gastric lesions should go parallel and neither should be a substitute of each other