Endoscopic Tumor Diagnosis and Treatment

Epidemiology and Screening

There are many risk factors for carcinogenesis, including cigarette smoking, alcohol, coffee drinking. However, it is difficult to investigate the extent to which such factors are significantly responsible for the development of cancer. Kaneko et al. investigated whether daily consumption of alcohol and/or cigarette smoking is related to an initial esophageal carcinoma lesion [1]. Video endoscopy with Lugol staining was carried out in 1257 consecutive patients - 641 with daily consumption of alcohol and/or cigarettes, representing a high-risk population, and 616 patients alcohol or cigarette consumption, representing a low-risk population. The rate of low-grade dysplasia (LGD) in the high-risk population was 1.7 % (11/641), compared with 1.8 % (11/616) in the low-risk population (P = 0.925); for high-grade dysplasia (HGD), the figures were 2.0 % (13/641) vs. 0.3 % (2/616) (P < 0.0001). The rates of alcohol drinking and/or cigarette smoking in patients with LGD, HGD, and invasive carcinoma were 50 % (11/22), 87 % (13/15), and 90 % (63/70), respectively. The authors concluded that daily consumption of alcohol and/or cigarettes is not significantly related to the initiation of carcinogenesis in the esophagus, but they suggest that such consumption may act as a promoter for progression from LGD to HGD.

Chang et al. also reported on the clinical, endoscopic, and pathological features in 53 patients with superficial esophageal cancer [2]. Forty-two of the patients reported alcohol consumption, 40 were smokers, one had corrosive esophagitis, and one had Barrett’s esophagus. Associated malignancies included head and neck cancer (n = 3), gastric cancer (n = 7), and bladder cancer (n = 1). At the time of diagnosis, 29 of the patients (54.7 %) had esophageal symptoms, whereas 24 patients (45.3 %) presented with nonspecific symptoms or were detected during routine check-up. The endoscopic findings showed that the superficial type of lesion was most frequent (35.8 %), and the lesions were most commonly located in the mid-esophagus (64.2 %). Forty-five patients (84.9 %) underwent surgical resection, and eight (15.1 %) received endoscopic resection. Thirty-five patients (66 %) showed submucosal involvement, 12 patients (22.6 %) intramucosal involvement, and six patients (11.3 %) had lesions limited to the epithelium. There were lymph-node metastases from intramucosal cancers in two patients (11 %), whereas eight (22.9 %) of those with submucosal cancer had lymph-node metastases.

There also appear to be risk factors for gastric cancer such as Helicobacter pylori infection, salt consumption, nitrosourea, and genetic factors. Ng et al. reported an increased frequency of premalignant gastric lesions in first-degree relatives of gastric cancer patients [3]. A total of 65 first-degree relatives of 25 index cancer patients and 95 control individuals were studied. Gastric cancer relatives had similar H. pylori infection rates to those of the control patients (56.8 % vs. 61.5 %, P = 0.08). The active and chronic inflammation scores on the Sydney system were also comparable. However, intestinal metaplasia and dysplasia were significantly more frequent in relatives than in controls (intestinal dysplasia 41.5 % vs. 15.8 %, P = 0.001; dysplasia: 9.8 % vs. 0 %, P = 0.003).

Gastric intestinal metaplasia is commonly found in first-degree relatives of gastric cancer patients. Factors in addition to H. pylori infection are likely to contribute to the development of premalignant gastric lesions in family members. Gastric intestinal metaplasia is generally considered to be a precursor lesion in the development of intestinal-type adenocarcinoma. Shen et al. concluded that aberrant expression of monoclonal antibody (mAb) Das-1 reactive antigen of the colonic phenotype in both precancerous lesions (intestinal metaplasia) and gastric adenocarcinoma may be clinically significant for early detection or possible endoscopic surveillance [4].

The early detection of stomach cancer, mainly thanks to mass screening (usually using radiography) has led to better survival rates in Japan. Dan et al. conducted a cost-effectiveness analysis to identify population subgroups who might benefit from a mass endoscopic screening program in Singapore [5]. The study was carried out in the male population in Singapore at intermediate risk for stomach cancer, comparing a group receiving mass screening and a group without. Screening of the Singapore male population over the age of 50 (340 000 patients) using endoscopy every 2 years resulted in the prevention of 4272 additional stomach cancer deaths. The cost of averting one cancer death was equivalent to US$ 129 800, and the cost benefit of the screening program was US$ 12 810 per quality-adjusted life year saved. The authors concluded that screening for gastric cancer in a moderate to high-risk population subgroup is potentially cost-effective.

References

• 1 Kaneko K, Konishi K, Kurahashi T. et al . Is daily consumption of alcohol and cigarettes related to development of esophageal squamous cell carcinoma?.  Gastrointest Endosc. 2002;  55 AB223
• 2 Chang H S, Jung H Y, Park S I. et al . Superficial esophageal cancer: a report of 53 cases.  Gastrointest Endosc. 2002;  55 AB223
• 3 Ng E KW, Leung W K, Chang W Y. et al . Increased frequency of pre-malignant gastric lesions in first degree relatives of stomach cancer patients.  Gastroenterology. 2002;  122 A-17
• 4 Shen B, Shen C, Dumot J. et al . Aberrant expression of a colon-specific antigen in gastric intestinal metaplasia and adjacent adenocarcinoma.  Gastrointest Endosc. 2002;  55 AB102
• 5 Dan Y Y, Yeoh K G, So J. Cost-effectiveness of screening for cancer of stomach using endoscopy.  Gastroenterology. 2002;  122 A-483
• 6 Pinchon N, Vincensini J F, Cessot F. et al . The value of Lugol’s staining for early screening of esophageal malignancies.  Gastrointest Endosc. 2002;  55 AB222
• 7 Kaneko K, Konishi K, Kurihashi T. et al . Successful screening of esophageal dysplasia and carcinoma by routine endoscopy.  Gastrointest Endosc. 2002;  55 AB219
• 8 Yao K, Matsui T, Yao T. et al . Microvascular architecture in intramucosal gastric carcinoma: novel findings by magnifying endoscopy.  Gastrointest Endosc. 2002;  55 AB128
• 9 Jung J S, Jang J Y, Cho J Y. et al . Comparison between magnifying endoscopy and histologic finding in the elevated lesions of stomach.  Gastrointest Endosc. 2002;  55 AB130
• 10 Dinis-Ribeiro M J, Costa-Pereira A, Lopes C. et al . Definition of chromoendoscopy and magnification endoscopic pattern for diagnosis of gastric adenocarcinoma associated lesions.  Gastrointest Endosc. 2002;  55 AB106
• 11 Kumagai Y, Inoue H. Micro-vascular architecture of superficial squamous cell carcinoma of the stomach.  Gastrointest Endosc. 2002;  55 AB224
• 12 Jang J Y, Cho J Y, Jung J S. et al . The usefulness of magnifying endoscopy for iodine-unstained lesion of esophagus in high-risk populations of esophageal cancer.  Gastrointest Endosc. 2002;  55 AB221
• 13 Nakayoshi T, Fujisaki J, Matsuda K. et al . Preliminary experience of magnifying endoscopy with narrow band imaging system for early gastric cancer.  Gastrointest Endosc. 2002;  55 AB106
• 14 Dore M P, Pironti A, Marras L. et al . Gastric MALT lymphoma: the value of biopsy performed routinely during endoscopic evaluation.  Gastroenterology. 2002;  122 A-175
• 15 Morgner A, Alpen B, Thiede C. et al . Long-term follow-up, relapses, and secondary malignancies in patients with primary low-grade gastric MALT lymphoma and H. pylori infection after eradication therapy.  Gastroenterology. 2002;  122 A-172
• 16 Fischbach W, Goebeler M E, Keller R. et al . Increased experience with minimal residuals of low-grade gastric MALT-type lymphoma after eradication of H. pylori and molecular findings.  Gastroenterology. 2002;  122 A-174
• 17 Jafri S F, Nguyen P T. The evaluation of four different solutions for submucosal injection in endoscopic mucosal resection (EMR).  Gastrointest Endosc. 2002;  55 AB252
• 18 Sumiyoshi T, Fujii T, Sumiyoshi Y. et al . Injected substances to the submucosa in endoscopic mucosal resection glycerin solution versus normal saline solution.  Gastrointest Endosc. 2002;  55 AB110
• 19 Feitoza A B, Gostout C J, Burgart L. et al . Hydroxypropyl methylcellulose: a better submucosal fluid cushion for endoscopic mucosal resection.  Gastrointest Endosc. 2002;  55 AB111
• 20 Momma K, Yoshida M, Yamada Y. et al . Endoscopic estimation of mucosal cancer of the esophagus.  Gastrointest Endosc. 2002;  55 AB220
• 21 Lagarrigue J P, Ponchon T, Saurin J C. et al . Endoscopic mucosal resection (EMR) in the esophagus: discrepancies between endoscopic and histological results.  Gastrointest Endosc. 2002;  55 AB221
• 22 Pech O, Abdollahnia R, Gossner L. et al . Endoscopic mucosal resection of superficial esophageal squamous cell carcinomas and high-grade intraepithelial neoplasia: European experiences.  Gastrointest Endosc. 2002;  55 AB224
• 23 Shimizu Y, Kato M, Tsukagoshi H. et al . Long-term outcome after endoscopic resection in patients with squamous cell carcinoma of the esophagus invading the muscularis mucosae or deeper.  Gastrointest Endosc. 2002;  55 AB220
• 24 Lew R J, Scotiniotis I A, Kochman M L. et al . Long-term outcomes of esophagectomy, endoscopic mucosal resection, or photodynamic therapy for superficial esophageal cancer.  Gastrointest Endosc. 2002;  55 AB219
• 25 Kumai K, Imaeda H, Aiura K. et al . Outcomes of long-term after endoscopic and laparoscopic surgery for early gastric cancer.  Gastroenterology. 2002;  122 A-333
• 26 Laurent S, Piessevaux H, Sempoux C. et al . Endoscopic resection and ablation of benign and malignant tumors of the upper gastrointestinal tract.  Gastrointest Endosc. 2002;  55 AB222
• 27 Yamamoto H, Kawata H, Sunada K. et al . Endoscopic en bloc resection of large superficial gastric tumors by using sodium hyaluronate and small-caliber-tip transparent hood.  Gastrointest Endosc. 2002;  55 AB105
• 28 Farrel J J, Lauwers G Y, Brugge W. et al . Endoscopic mucosal resection using a cap (EMR-C) improves tissue resection and pathologic assessment: an animal study.  Gastrointest Endosc. 2002;  55 AB105
• 29 Jung H Y, Kim B S, Oh S T. et al . Curative endoscopic resection for early gastric cancer; endoscopic mucosal resection after precutting using needle knife.  Gastrointest Endosc. 2002;  55 AB102
• 30 Bergman J J, Fockens P, van Lanschot J JB. et al . A flexible large caliber EMR-cap for endoscopic mucosal resection (EMR) of early gastroesophageal cancer allows for safe removal of large specimen.  Gastrointest Endosc. 2002;  55 AB112
• 31 Tanabe S, Koizumi W, Nakai H. et al . Usefulness of new technique (endoscopic oblique aspiration mucosectomy) as compared with strip biopsy for the treatment of superficial esophageal cancer.  Gastrointest Endosc. 2002;  55 AB115
• 32 May A, Gossner L, Behrens A. et al . Suck and cut mucosectomy in early esophageal carcinoma: ligation device versus Inoue cap: a prospective comparison in 100 resections.  Gastrointest Endosc. 2002;  55 AB113
• 33 Enomoto S, Yahagi N, Fujishiro M. et al . Endoscopic hemostasis using high-frequency hemostatic forceps and water-jet system during endoscopic mucosal resection.  Gastrointest Endosc. 2002;  55 AB115
• 34 Montani A, Fujisawa Y, Shiba M. et al . Analysis of discrepancies between endoscopic diagnosis and histological examination of biopsy specimen of gastric tumors.  Gastrointest Endosc. 2002;  55 AB103
• 35 Kraft D, Saurin J C, Napoleon B. et al . Feasibility and complication of endoscopic mucosal resection for sporadic sessile duodenal adenomas.  Gastrointest Endosc. 2002;  55 AB137
• 36 Apel D, Spiethoff A, Vogt S. et al . Villous tumors of duodenum: a retrospective follow-up of 20 patients after endoscopic therapy.  Gastrointest Endosc. 2002;  55 AB138
• 37 Disario J, Samowitz W, Burt S. et al . Endoscopic therapy of large gastroduodenal polyps in familial adenomatous polyposis.  Gastrointest Endosc. 2002;  55 AB138
• 38 Ritz J, Isbert C, Lehman K. et al . Determining the optical parameters of healthy esophageal tissue and esophageal carcinomas to develop an irradiation model for photodynamic therapy.  Gastroenterology. 2002;  122 A-347
• 39 Nakamura T, Ishii Y, Ejiri K. et al . Photodynamic therapy using transparent hood for superficial esophageal cancer.  Gastrointest Endosc. 2002;  55 AB220
• 40 Takahira K, Sano M, Arai H. et al . Photodynamic therapy with excimer dye laser for gastric cancer.  Gastrointest Endosc. 2002;  55 AB110
• 41 Kim Y S, Chun H J, Oh Y L. et al . endoscopic resection of submucosal tumor of the esophagus: 15-year experience and long-term follow-up.  Gastrointest Endosc. 2002;  55 AB162
• 42 Lee S W, Moon Y S, Yoo S J. et al . The usefulness of Endoclip marking for determining surgical margin in early gastric cancer.  Gastrointest Endosc. 2002;  55 AB104
• 43 Homs M YV, Blankenstein M V, Haringsma J. et al . Re-intervention after self-expandable metal stent placement for palliation of esophageal carcinoma.  Gastrointest Endosc. 2002;  55 AB221
• 44 Dua K S, Moura E GHD, Sakai P. et al . Multicenter prospective evaluation of an anti-reflux expandable metal esophageal stent for palliation of malignant dysphagia.  Gastrointest Endosc. 2002;  55 AB221
• 45 Kim J H, Kim W S, Lee K M. et al . New covered self-expanding nitinol stent for palliation of malignant esophago-cardial obstruction: long-term results.  Gastrointest Endosc. 2002;  55 AB119
• 46 Canto M I, Smith C, McClelland L. et al . Randomized trial of PDT vs. stent for palliation of malignant dysphagia: cost-effectiveness and quality of life.  Gastrointest Endosc. 2002;  55 AB100
• 47 Homann N, Noftz M, Klingenberg R. et al . Late complications of self-expandable metal stent in malignant esophageal stenosis: possibility of reintervention.  Gastrointest Endosc. 2002;  55 AB223
• 48 Sarmiento R, Ng E KW, Chan A CW. et al . Management of late complications after insertion of endoscopic self-expandable metal stent for inoperable malignant dysphagia: a 5-year experience in 122 patients.  Gastrointest Endosc. 2002;  55 AB222
• 49 Binnie J AH, Cameron E, Phillips W. et al . Relief of malignant dysphagia with placement of oesophageal metal stent: do the benefits outweigh the risks?.  Gastrointest Endosc. 2002;  55 AB163
• 50 Mizumoto Y, Maekawa T, Kogawa K. et al . Clinical evaluation of Gore-Tex Ultraflex stent with anti-reflux valve in lower esophagocardial cancer: a multicenter study.  Gastrointest Endosc. 2002;  55 AB113
• 51 Park Y S, Lee J D, Lee H S. et al . Use of a newly-designed esophageal stent with anti-reflux valve in the treatment of malignant cardiac obstruction: a preliminary report.  Gastrointest Endosc. 2002;  55 AB111
• 52 Prat F P, Meduri T NB, Fritsch J. et al . Endoscopic palliation of malignant duodenal strictures by self-expandable metallic stent.  Gastrointest Endosc. 2002;  55 AB137
• 53 Kim J H, Kim S W, Lee K M. et al . New covered through-the-scope (TTS) stent for palliation of inoperable malignant upper GI obstruction.  Gastrointest Endosc. 2002;  55 AB116
• 54 Mazzaglia P, Howell D A, Sheth S G. et al . Enteric stent placement for duodenal obstruction complicating pancreatic carcinoma: poor outcome demands caution.  Gastrointest Endosc. 2002;  55 AB139
• 55 Nugent S, Stone A, Benson M. Enteral stent placement for malignant gastric outflow obstruction successes and failures.  Gastrointest Endosc. 2002;  55 AB139
• 56 Legoux J L, Smith D, Kerjean A. et al . Endoscopic intestinal stent for malignant antro-duodenal stricture: follow-up of 11 patients.  Gastrointest Endosc. 2002;  55 AB103
• 57 Holt A P, Ahmed M. Palliation of malignant pyloro-duodenal obstruction with self-expanding metal stents (SEMS) in a district general hospital.  Gastrointest Endosc. 2002;  55 AB104
• 58 Tanaka H, Tsuda T, Mochizuki T. et al . Gastric and duodenal stenting for malignant stenosis, including endoscopic repair of stent.  Gastroenterology. 2002;  122 A444
• 59 White R E, Mungatana C, Bett C. et al . Endoscopic management following iatrogenic perforation of esophageal malignancies.  Gastrointest Endosc. 2002;  55 AB224
• 60 Furtwangler A R, Rueckauer K D, Imdahl A. et al . Stent application for anastomotic leakage after total gastrectomy in patients with gastric cancer.  Gastroenterology. 2002;  122 A333
• 61 Friedland S, Soetikno R, Alto P. et al . Modification of metallic stents to facilitate repositioning and removal.  Gastrointest Endosc. 2002;  55 AB111
• 62 Homs M YV, Hansen B E, Haringsma J. et al . Prior radiation and/or chemotherapy for esophageal carcinoma has no effect on the outcome of self-expanding metal stent placement.  Gastrointest Endosc. 2002;  55 AB222
• 63 Piano M D, Montino F, Ballare M. et al . Use of alternating magnetic field to control metal stent ingrowth and overgrowth: a theoretical study.  Gastrointest Endosc. 2002;  55 AB112