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World J Gastrointest Oncol. Oct 15, 2019; 11(10): 830-841
Published online Oct 15, 2019. doi: 10.4251/wjgo.v11.i10.830
Endoscopic management of esophageal cancer
Osman Ahmed, Jaffer A Ajani, Jeffrey H Lee
Osman Ahmed, Jeffrey H Lee, Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
Jaffer A Ajani, Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
Author contributions: Ahmed O was involved in review design and drafting of the manuscript; Ajani JA was involved in critical revision of the manuscript; Lee JH was involved in review design and critical revision of the manuscript.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jeffrey H Lee, MD, Professor, Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, 1515 Holcombe Avenue, Houston, TX 77030, United States. jefflee@mdanderson.org
Telephone: +1-713-5638906 Fax: +1-713-5634408
Received: February 25, 2019
Peer-review started: February 26, 2019
First decision: April 15, 2019
Revised: May 29, 2019
Accepted: August 27, 2019
Article in press: August 28, 2019
Published online: October 15, 2019
Processing time: 234 Days and 11.7 Hours
Abstract

Esophageal cancer (EC) generally consists of squamous cell carcinoma (which arise from squamous epithelium) and adenocarcinoma (which arise from columnar epithelium). Due to the increased recognition of risk factors associated with EC and the development of screening programs, there has been an increase in the diagnosis of early EC. Early EC is amenable to curative therapy by endoscopy, which can be performed by either endoscopic resection or endoscopic ablation. Endoscopic resection consists of either endoscopic mucosal resection (preferred in cases of adenocarcinoma) or endoscopic submucosal dissection (preferred in cases of squamous cell carcinoma). Endoscopic ablation can be performed by either radiofrequency ablation, cryotherapy, argon plasma coagulation or photodynamic therapy, amongst others. Endoscopy can also assist in the management of complications post-esophageal surgery, such as anastomotic leaks and perforations. Finally, there is a growing role for endoscopy to manage end-of-life palliative symptoms, especially dysphagia. The growing use of esophageal stents, debulking therapy and dilation can assist in improving a patient’s quality of life. In this review, we examine the multiple roles of endoscopy in the management of patients with EC.

Keywords: Esophageal cancer; Endoscopy; Resection; Ablation; Stent; Barrett’s esophagus

Core tip: The endoscopic management of esophageal cancer is continuously evolving. Although, endoscopy was generally reserved for diagnosis, but due to the growing evidence around screening, early cancers are now being detected. Therefore, endoscopy has now grown to include an increasing therapeutic role in esophageal cancer. This includes resection by either endoscopic mucosal resection or endoscopic mucosal dissection. Ablative therapies by endoscopy including the use of radiofrequency ablation and photodynamic therapies are also growing. Finally, the role of endoscopy entails palliative management, such as the use of esophageal stent placements.