Diagnosis of Esophagogastric Tumors

Abstract

With regard to esophageal tumors, important reports on several topics have been published recently. 1) The place of endoscopic ultrasonography (EUS) as the best locoregional staging technique for cancer of the esophagus has been further consolidated. The addition of fine-needle aspiration makes EUS more sensitive than computed tomography (CT) and more accurate than CT or EUS alone for nodal staging. 2) High-resolution endoscopy with chromoendoscopy has been found to be very effective for mucosal lesions, but not for submucosal lesions. In combination with EUS, the sensitivity for submucosal tumors increases up to 60 %. 3) Autofluorescence-guided biopsy has been reported to be a good tool for detecting high-grade dysplasia. A narrow-band imaging system improved the overall accuracy for depth of invasion. 4) The incidence of hypopharyngeal cancer increases after resection for esophageal carcinoma. Patients with a scattered staining pattern after application of Lugol's solution are more prone to develop upper lesions. 5) Fluorescence imaging makes it possible to detect low-grade intraepithelial neoplasia in Barrett's mucosa, with fewer biopsies. 6) Patients with Barrett's esophagus with a length of over 3 cm had a significantly greater prevalence of dysplasia in comparison with those in the whom the Barrett's segment was shorter than 3 cm (23 % vs. 9 %, P = 0.0001). With regard to gastric tumors, 1) Helicobacter pylori eradication can significantly reduce the development of gastric cancer, but only in patients without precancerous lesions. 2) Intestinal metaplasia types II and III have been shown to have a higher rate of progression to low-grade dysplasia than type I. 3) With regard to screening in asymptomatic individuals, serum pepsinogen may represent an alternative to conventional fluoroscopy methods. 4) In patients who have undergone esophagectomy for esophageal cancer, annual follow-up endoscopies are vital for detecting early secondary gastric cancer and ulcerations in which curative treatment is possible. 5) High-resolution endoscopy allows more precise diagnosis of early gastric cancer. The presence of irregular minute vessels and variations in vessel caliber were found to be specific of early gastric cancer. The small regular pattern of sulci and ridges was observed significantly more frequently in differentiated carcinoma than in undifferentiated carcinoma. 6) Infrared-ray electronic endoscopy combined with indocyanine green injection appears to be effective in detecting sentinel nodes that contain metastases in patients with gastric cancer. 7) Gastric adenocarcinoma was found to show specific changes in the fluorescence spectra emitted, in comparison with normal gastric mucosa. However, there was wide variation in the emitted autofluorescence spectra in gastric cancer with signet-ring cells in comparison with normal mucosa.

Incidence, endoscopic morphology and distribution of metastatic lesions in the gastrointestinal tract

“…Melanoma as a primary lesion had been found to be associated with metastasizing to the upper GIT in our study but not so commonly as has been reported previously. 3,5,6,20 Rather, from our study, hepatocellular carcinoma was found to be a primary lesion that was rather commonly associated with metastasizing to the upper GIT, whereas previously it appears that such an example had been reported as a single case study only. 21 We speculate that such a difference might be explained by the rather high incidence of hepatocellular carcinoma in Taiwan as compared to Western countries, 22 this lesion type being the most common cancer in Taiwan.…”

“…Lung cancer, breast cancer and melanoma were the three cancers reported to be most commonly associated with metastasis to the upper GIT. 3,5,6,20 Our results showed that lung cancer, hepatocellular carcinoma, colorectal cancer and breast cancers were the cancers commonly associated with metastasis to the upper GIT. Melanoma as a primary lesion had been found to be associated with metastasizing to the upper GIT in our study but not so commonly as has been reported previously.…”

Staging accuracy of endoscopic ultrasound performed by nonexpert endosonographers in patients with resectable esophageal squamous cell carcinoma: is it possible?

“…However, CT is unable to accurately distinguish T-stages, particularly T1 and T2. 20 Furthermore, the assessment of staging for esophageal squamous cell carcinoma is not performed by EUS alone in actual clinical practice. Second, the small sample size was also a limitation.…”

A care pathway for patients with oesophageal cancer

“…2004). Finally, if peritoneal metastases are suspected, a diagnostic laparoscopy is conducted (Moreto 2001).…”