Esophageal Cancer: An Updated Review

Michael DiSiena, MD; Alexander Perelman, DO; John Birk, MD; Houman Rezaizadeh, MD

Disclosures

South Med J. 2021;114(3):161-168. 

In This Article

Diagnosis

Although computed tomography (CT) scans and barium contrast studies can detect esophageal lesions, they may miss early cancerous lesions. These studies, however, are useful for identifying strictures or fistulas, and in the case of CT scans, play a role in staging/identifying metastases. The primary tool for EC diagnosis is endoscopy with biopsies. Upper endoscopy with biopsies allows the clinician to acquire histologic samples and is very accurate at identifying EC. A study from 1982 showed that endoscopy with biopsy was 93% accurate with 1 biopsy taken, 98% with 7 biopsies taken, and 100% with biopsy and brush cytology.[60] Video capsule endoscopy (VCE) has been insufficient for the diagnosis of EC because of the short transit time through the esophagus and a lack of ability to obtain histology.[61] Continued technological improvements are being introduced, however, to advance the diagnostic yield of VCE, such as remote magnetic control systems that allow it to overcome the rapid transit time of the esophagus, modification of the light source with a flexible spectral imaging color-enhancement system to help diagnose EC, and ex vivo research has demonstrated that targeted biopsy using magnetic capsule endoscopy and a self-folding microgripper is possible.[62–64] As these advances progress, VCE may become a practical diagnostic option. EsophaCap (CapNostics, Concord, NC), a capsule that dissolves to release a sponge that collects genetic material from the esophagus as it is retrieved via a string, has been studied to diagnosis Barrett's, and it is possible that this will be modified for the use of EC diagnoses.[65]

processing....