Screening for Precancerous Lesions of Upper Gastrointestinal Tract: From the Endoscopists' Viewpoint

Abstract

Upper gastrointestinal tract cancers are one of the most important leading causes of cancer death worldwide. Diagnosis at late stages always brings about poor outcome of these malignancies. The early detection of precancerous or early cancerous lesions of gastrointestinal tract is therefore of utmost importance to improve the overall outcome and maintain a good quality of life of patients. The desire of endoscopists to visualize the invisibles under conventional white-light endoscopy has accelerated the advancements in endoscopy technologies. Nowadays, image-enhanced endoscopy which utilizes optical- or dye-based contrasting techniques has been widely applied in endoscopic screening program of gastrointestinal tract malignancies. These contrasting endoscopic technologies not only improve the visualization of early foci missed by conventional endoscopy, but also gain the insight of histopathology and tumor invasiveness, that is so-called optical biopsy. Here, we will review the application of advanced endoscopy technique in screening program of upper gastrointestinal tract cancers.

Image‐enhanced endoscopy for detection of second primary neoplasm in patients with esophageal and head and neck cancer: A systematic review and meta‐analysis

“…Image‐enhanced endoscopy, which includes equipment and dye‐based techniques, has been proposed as a better screening tool than conventional white‐light imaging (WLI) endoscopy for gastrointestinal tract cancers . Several different methods for image‐enhanced endoscopy have been applied to esophageal cancer screening, and among them, the narrow band imaging (NBI) system and Lugol chromoendoscopy are well known and efficient in the detection of malignancies of the squamous cell epithelium . The characteristics of neovascularization and the depletion of intracellular glycogen during the cancerization of the squamous epithelium lead to brownish discoloration and white‐pink unstained malignant mucosa under NBI and Lugol chromoendoscopy, respectively .…”

Development and validation of a classification and scoring system for the diagnosis of oral squamous cell carcinomas through confocal laser endomicroscopy

“…Recent studies showed promising results regarding a transfer of this imaging method to the area of the head and neck with a sufficient differentiation of pathological lesions to physiological tissue in the upper gastrointestinal tract like pharynx, larynx and the esophagus [3, 24–26]. Furthermore, preliminary results regarding CLE examinations in the oral cavity showed potentials for detecting cancerous lesions even in their early forms.…”

“…Furthermore, preliminary results regarding CLE examinations in the oral cavity showed potentials for detecting cancerous lesions even in their early forms. However, these studies were mainly performed either with an experimental set-up, in ex vivo settings, on animal models or with fluorescent agents not suitable for a routine clinical investigation [3, 13, 19–22, 24–26]. …”

Precancerous Lesions in Gastrointestinal Tract

“…3,9,21 Gastrointestinal endoscopy must be done regularly and consists of esophagogastroduodenoscopy, colonoscopy and enteroscopy with Chromo-endoscopy staining (blue methylen, indigocarmine, Lugol) or Narrow band imaging technique (NBI) or endo-microscopy examinations. Histopathology examination is an important examination that should be performed to diagnose the presence of precancerous lesions.…”

“…[26][27][28] Examination with high sensitivity and specificity close to 100% to diagnose precancerous lesion/ cancer are esophagogastroduodenoscopy examination, colonoscopy, enteroscopy, Chromo-endoscopy and confocal laser endomicroscopy with biopsy examination and histopathology examination. 21,29 These supporting examinations must be performed periodically to monitor the progress of precancerous lesions.…”