Current Trends in Endoscopic Diagnosis and Treatment of Early Esophageal Cancer

Abstract

Diagnosis of esophageal adenocarcinoma mostly occurs in the context of reflux disease or surveillance of Barrett´s metaplasia. Optimal detection rates are obtained with high definition and virtual or dye chromoendoscopy. Smaller lesions can be treated with endoscopic mucosal resection. Endoscopic submucosal dissection (ESD) is an option for larger lesions. Endoscopic resection is considered curative (i.e., without significant risk of lymph node metastasis) if histopathology confirms en bloc and R0 resection of a well-differentiated (G1/2) tumor without infiltration of lymphatic or blood vessels and the maximal submucosal infiltration depth is 500µm. Ablation of remaining Barrett’s metaplasia is important, to reduce the risk of metachronous cancer. Esophageal squamous cell cancer is associated with different risk factors, and most of the detected lesions are diagnosed during upper gastrointestinal endoscopy for other indications. Virtual high definition and dye chromoendoscopy with Lugol´s solution are used for screening and evaluation. ESD is the preferred resection technique. The criteria for curative resection are similar to Barrett´s cancer, but the maximum infiltration depth must not exceed lamina propria mucosae. Although a submucosal infiltration depth of up to 200 µm carries a substantial risk of lymph node metastasis, ESD combined with adjuvant chemo-radiotherapy gives excellent results. The complication rates of endoscopic resection are low, and the functional outcomes are favorable compared to surgery.

Evaluation of Spectrum-Aided Visual Enhancer (SAVE) in Esophageal Cancer Detection Using YOLO Frameworks

“…EC often cannot be discovered in time because of its asymptomatic or symptom-atypical characteristics in early stage, and the early detection of EC can improve the survival rate [ 50 , 51 , 52 ]. This study underscored the potential of HSI-based conversion algorithms, showcasing their capability to convert WLI images into HSI images for effective early EC classification and detection.…”

Pathology Reporting of Esophagus Endoscopic Resections: Recommendations From the International Collaboration on Cancer Reporting

“…[16][17][18] The success rate of treatment is also good for deeper submucosal esophageal lesions with a reduction in positive lateral margins. [24][25][26] Thus, pathologists will be faced with an increasing number of ER specimens, as opposed to a surgically resected specimens, in the management of esophageal carcinoma.…”

Endoscopic submucosal dissection versus esophagectomy for t1 esophageal squamous cell carcinoma: a propensity score-matched analysis

“…Endoscopic ultrasound (EUS) is widely used to assess the invasion depth, but was reported to have a relatively low diagnostic accuracy. 27 , 28 Ishihara et al explored the performance of EUS after conventional endoscopy for the diagnosis of ESCC invasion depth. They found that additional EUS did not improve the diagnostic performance of non-magnifying and magnifying endoscopy in evaluating the invasion depth of T1 ESCC.…”