Diagnosis of esophagogastric tumors

Abstract

Esophagogastric tumors occur in three sectors: the esophagus, the EG junction and the non-cardia stomach. Neoplasia develops in the squamous stratified epithelium of the esophagus and in the columnar epithelium of the Barrett's esophagus or in the stomach. At the junction, tumors arise either in a very short Barrett's esophagus or in the gastric epithelium of the cardia. The prognosis of tumors detected at the advanced stage is poor. Secondary prevention requires detection at the early stage. Most superficial neoplastic lesions in the esophagus and in the stomach have a non-protruding appearance, which is similar for premalignant and malignant lesions. Improved accuracy in endoscopic diagnosis and prediction of histology prior to biopsy and treatment decision is based upon magnification with a optical zoom and electronic processing of the captured image with structure enhancement, enhancement of the color of hemoglobin and narrow band imaging. This applies particularly to the exploration of the Barrett's esophagus for identification of the areas with intestinal metaplasia and of flat neoplastic areas. In spite of the predictive value of endoscopy for histology, biopsy samples are still required for pathology and eventually studies with biological markers. Spectroscopic techniques provide a new perspective, up to the level of molecular endoscopy, but they are unlikely to be cost/effective. The classification in the sub-types 0 of neoplastic lesions has some relevance to prediction of depth of invasion. In the esophagus, EUS staging with high frequency miniprobes is a useful complement.