Endoscopic Management of Early Adenocarcinoma and Squamous Cell Carcinoma of the Esophagus: Screening, Diagnosis, and Therapy

Gastroenterology. 2018 Jan;154(2):421-436. doi: 10.1053/j.gastro.2017.07.041. Epub 2017 Aug 2.

Abstract

Because the esophagus is easily accessible with endoscopy, early diagnosis and curative treatment of esophageal cancer is possible. However, diagnosis is often delayed because symptoms are not specific during early stages of tumor development. The onset of dysphagia is associated with advanced disease, which has a survival at 5 years lower than 15%. Population screening by endoscopy is not cost-effective, but a number of alternative imaging and cell analysis technologies are under investigation. The ideal screening test should be inexpensive, well tolerated, and applicable to primary care. Over the past 10 years, significant progress has been made in endoscopic diagnosis and treatment of dysplasia (squamous and Barrett's), and early esophageal cancer using resection and ablation technologies supported by evidence from randomized controlled trials. We review the state-of-the-art technologies for early diagnosis and minimally invasive treatment, which together could reduce the burden of disease.

Keywords: Barrett’s Esophagus; Endoscopy; Esophageal Cancer; Screening.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Ablation Techniques / methods
  • Adenocarcinoma / blood
  • Adenocarcinoma / diagnosis
  • Adenocarcinoma / pathology
  • Adenocarcinoma / surgery*
  • Barrett Esophagus / blood
  • Barrett Esophagus / diagnosis*
  • Barrett Esophagus / pathology
  • Barrett Esophagus / surgery
  • Biomarkers, Tumor / blood
  • Biopsy
  • Breath Tests
  • Capsule Endoscopy
  • Carcinoma, Squamous Cell / blood
  • Carcinoma, Squamous Cell / diagnosis
  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Squamous Cell / surgery*
  • Coloring Agents / administration & dosage
  • Early Detection of Cancer / methods*
  • Esophageal Neoplasms / blood
  • Esophageal Neoplasms / diagnosis
  • Esophageal Neoplasms / pathology
  • Esophageal Neoplasms / surgery*
  • Esophageal Squamous Cell Carcinoma
  • Esophagectomy / methods*
  • Esophagoscopy / instrumentation
  • Esophagoscopy / methods*
  • Esophagus / diagnostic imaging
  • Esophagus / pathology
  • Esophagus / surgery
  • Humans
  • Immunohistochemistry
  • Lasers
  • Randomized Controlled Trials as Topic

Substances

  • Biomarkers, Tumor
  • Coloring Agents

Supplementary concepts

  • Adenocarcinoma Of Esophagus