The role of upper gastrointestinal endoscopy in patients with cancer

Abstract

The last decade has seen considerable advance in the application of fiberoptic endoscopy to the diagnosis and management of patients with cancer. Forward and side-viewing instruments have been developed that have complete tip control, potential for obtaining directed biopsies, brush and lavage cytology, and for aspiration of material for assay of enzymes and tumor-associated antigens. These features have provided a high degree of diagnostic capability in the esophagus, stomach, and duodenum. Accurate histologic diagnoses require multiple biopsies and brush cytology from each lesion. Lavage cytology has been useful in selected patients, especially those with diffusely infiltrating lesions. Brush cytology has been especially helpful in patients with stenotic esophageal cancer. These techniques have also provided a diagnosis in a high percentage of patients with lymphoma involving the stomach. Endoscopy has also been very useful in patients with nongastrointestinal cancer who have major gastrointestinal problems such as bleeding stress ulcers or monilial esophagitis.

Percutaneous fine-needle aspiration of gastrointestinal wall lesions with image guidance

“…[3][4][5] Gastrointestinal tract lesions are conventionally examined using barium studies, endoscopy, 6 and biopsy; most GI cytology involves endoscopically guided direct brushings of visible lesions. [7][8][9] However, submucosal, intramural, and subserosal lesions are generally not accessible by conventional endoscopic biopsy. 10 Endoscopic ultrasound-guided FNA of these lesions shows promising results, although sensitivities for the diagnosis of bowel-wall lesions by this method have been variously reported as from 61-85%.…”

Clinicopathologic Features and Treatment of Residual Early Cancers After Endoscopic Mucosal Resection of the Stomach

“…To confirm the accuracy of the diagnosis for cancer spread and depth before EMR, a side-viewing endoscopy with dye spray or amplified endoscopy may be useful. 18,19 For successful EMR, another important issue is the type of EMR procedure employed. There are several popular EMR procedures including the SB method 20 and EMR using a cap-fitted panendoscope (EMRC).…”

Accuracy of oesophageal brush cytology: Results of a prospective study and multicentre slide exchange

“…Of this group of four incorrect diagnoses, two were from adenocarcinomas and two from anaplastic tumours. Whilst 100 per cent accuracy may be achieved in brushings from squamous carcinomas (4), these results emphasize the special difficulty of distinguishing severe inflammatory changes from adenocarcinoma at the gastro-oesophageal junction (6,16).…”