Role of endoscopy in the diagnosis, staging, and management of esophageal cancer

Abstract

The incidence of esophageal adenocarcinoma (EAC) has increased approximately 700% since the late 1970s with over 10,000 cases diagnosed annually, outpacing the rate of growth of other major epithelial malignancies. Meanwhile, the incidence of esophageal squamous cell carcinoma (ESCC) has declined over several decades. While SCC is not felt to be preceded by a premalignant condition amenable to screening, EAC is preceded by Barrett’s esophagus (BE) in a metaplasia-dysplasia-carcinoma sequence. BE has been a target for screening efforts and eradication via endoscopic approaches in order to detect and prevent EAC. The risk of developing EAC among patients with non-dysplastic BE is approximately 0.4–0.5% per year but is much higher in patients with high-grade dysplasia. The relatively good 5-year prognosis in early-stage disease has led to efforts aimed at detecting progression to cancer or dysplasia in patients with BE. Screening is recommended for patients with non-dysplastic BE. For patients that progress to dysplasia, the current standard approach involves endoscopic mucosal resection and radiofrequency ablation. Highly select early esophageal cancers may in some cases also be managed endoscopically. The use of endoscopy for the prevention, diagnosis, and treatment of esophageal cancer continues to evolve.