Upper Gastrointestinal Tumors

Diagnostic Aspects

The diagnosis of early gastric cancer has long been regarded as a speciality of the Japanese, and Western endoscopic series have not found increasing numbers of early cancers among all gastric carcinoma cases diagnosed - as shown in an American series comparing two 10 - 15-year periods (16 % early cancers in 1975 - 1984 and 17 % in 1990 - 2000) [1]. In Japanese Americans, screening for gastric cancer using serum pepsinogen and endoscopy was evaluated in 776 asymptomatic persons in Seattle; 60 of 103 individuals invited underwent endoscopy, and two adenomas, no cancers, and 57 intestinal metaplasias were found on biopsy [2]. Similarly, 109 East Asians living in New York underwent endoscopy; one esophageal cancer was identified, and around 25 % of those studied had chronic active gastritis and intestinal metaplasia [3]. On the other hand, prediagnosis endoscopy in patients with distal esophageal adenocarcinoma was reported to be associated with a more favorable tumor stage than in control individuals who did not undergo endoscopy [4].

Sophisticated endoscopic techniques such as staining and magnification endoscopy have been described, although not for case-finding purposes (i. e., to improve the accuracy of screening) but for differential diagnosis of lesions identified by conventional endoscopy. Abstracts of two Japanese studies including 25 [5] and 306 patients [6], respectively, described features of gastric lesions on magnification endoscopy capable of being used to distinguish between benign and malignant cases. In one of these abstracts, a sensitivity of 95 % and a specificity of 96 % were reported [6]. Another Japanese study claimed that the margin of lesions can be defined more precisely using magnification endoscopy than with dye-staining [7]. Not unexpectedly, chromoendoscopy detected more adenomas in the duodenum of patients with familial adenomatous polyposis than standard endoscopy (mean 5.0 vs. 1.7; n = 10) [8]. Similarly, autofluorescence endoscopy was used in 55 patients with various gastric tumors; no ability to distinguish between cancer and adenoma was found, although all of the lesions were clearly differentiated from normal mucosa [9]. A “layer lifting” technique was reported that can be used to cut out a gross specimen using a needle knife and a smear to establish undiagnosed malignancy, in five patients with gastric wall thickening.

Finally, several abstracts dealt with regression of high-grade mucosa-associated lymphoid tissue (MALT) lymphoma after Helicobacter eradication [10], gastric involvement in T-cell leukemia/lymphoma [11], gastric plasmacytoma [12], and mantle-cell lymphoma [13].

References

• 1 Qian F, Jhang J S, Green P, et al. Early gastric cancer in the United States: failure of endoscopy to increase detection [abstract].  Gastrointest Endosc. 2001;  53 AB 214
• 2 Nietsch H, Namekata T, Rubin C E, et al. Gastric cancer screening in asymptomatic Japanese Americans using serum pepsinogen levels and endoscopy [abstract].  Gastrointest Endosc. 2001;  53 AB 209
• 3 Marcus S G, Tian H, Lam Y, et al. A prospective evaluation of esophagogastroduodenoscopy (EGD) in a population at increased risk for gastric cancer [abstract].  Gastroenterology. 2001;  120 A 488
• 4 Cooper G S, Yuan Z, Chak A, et al. Pre-diagnosis endoscopy is associated with improved staging and survival for adenocarcinoma of the esophagus and cardia [abstract].  Gastrointest Endosc. 2001;  53 AB 152
• 5 Yamaguchi Y, Takahashi H, Ukawa K, et al. Usefulness of magnifying endoscopy and new techniques for diagnosis of protruded early gastric cancer [abstract].  Gastrointest Endosc. 2001;  53 AB 123
• 6 Tajiri H, Doi T, Endo H, et al. The application of magnifying endoscopy to gastric cancer diagnosis: a prospective study [abstract].  Gastrointest Endosc. 2001;  53 AB 123
• 7 Otsuka Y, Goto H, Niwa Y, et al. The assessment of vertical and lateral invasion of early gastric cancer by magnifying endoscopy [abstract].  Gastrointest Endosc. 2001;  53 AB 212
• 8 Filiberti R, Bertario L, Sala P, et al. The role of chromoendoscopy in the surveillance of the duodenum of patients with familial adenomatous polyposis [abstract].  Gastrointest Endosc. 2001;  53 AB 64
• 9 Ohkawa A, Miwa H, Namihisa A, et al. Is the light induced fluorescence endoscopy (LIFE-GI) possible to differentially diagnose early gastric cancer and adenoma? [abstract].  Gastrointest Endosc. 2001;  53 AB 119
• 10 Suzuki T, Kato K, Sugiyama K, et al. Regression of gastric high-grade malt lymphomas after eradication of Helicobacter pylori infection [abstract].  Gastrointest Endosc. 2001;  53 AB 221
• 11 Ohnita K, Isomoto H, Kohno S. Gastric involvement in patients with adult T-cell leukemia/lymphoma and Helicobacter pylori infection [abstract].  Gastrointest Endosc. 2001;  53 AB 216
• 12 Kato K, Sugitani M, Ishii Y, et al. Long-term follow-up of the gastric plasmacytoma associated with Helicobacter pylori (HP) infection [abstract].  Gastrointest Endosc. 2001;  53 AB 215
• 13 Adams T L, Tio T L, Mayoral W, et al. Endoscopic features of mantel cell lymphoma involving the gastrointestinal tract [abstract].  Gastrointest Endosc. 2001;  53 AB 182
• 14 Ahmad N A, Kochman M L, Long W B, et al. Efficacy, safety and clinical outcomes of endoscopic mucosal resection (EMR): a study of 101 lesions [abstract].  Gastrointest Endosc. 2001;  53 AB 63
• 15 Itani A, Shiba M, Taguchi M, et al. Evaluation of endoscopic mucosal resection for treatment of early gastric cancer: assessment of post-operative complications [abstract].  Gastrointest Endosc. 2001;  53 AB 205
• 16 Parmar K S, Sierra Y, Reeves A, et al. Endoscopic mucosal resection associated complications towards safer EMR [abstract].  Gastrointest Endosc. 2001;  53 AB 75
• 17 Yamada Y, Momma K, Yoshida M. Endoscopic mucosal resection (EMR) for early esophageal cancer: double-channel technique [abstract].  Gastrointest Endosc. 2001;  53 AB 146
• 18 Horiuchi A, Maeyama H. A novel method of endoscopic mucosal resection using double endoscopes [abstract].  Gastrointest Endosc. 2001;  53 AB 213
• 19 Cho J Y, Ryu C B, Jung I S, et al. Usefulness of newly designed endoscopic mucosal resection method using a needle electrosurgical knife and scissor forceps for gastric flat adenoma and early gastric cancer [abstract].  Gastrointest Endosc. 2001;  53 AB 124
• 20 Yamamoto H, Sekine Y, Miyata T, et al. Endoscopic mucosal resection using sodium hyaluronate [abstract].  Gastrointest Endosc. 2001;  53 AB 131
• 21 Jung H Y, Lee M H, Kang G H, et al. Indication of endoscopic mucosal resection for early gastric cancer: are safe all patients with mucosal cancer?.  Gastrointest Endosc. 2001;  53 AB 208
• 22 Cheon Y K, Ryu C B, Jung I S, et al. The study of pathologic difference between endoscopic biopsy before EMR and histology of specimen after endoscopic mucosal resection (EMR) on gastric flat adenoma of early gastric cancer (EGC) [abstract].  Gastrointest Endosc. 2001;  53 AB 217
• 23 Hsu P I, Lai K H, Lo G H, et al. Sequential changes of gastric polyps following endoscopic ligation [abstract].  Gastrointest Endosc. 2001;  53 AB 218
• 24 Riccioni M E, Tringali A, Shah S, et al. Endoscopic palliation of malignant esophageal strictures with self-expanding metal stents: a prospective study comparing the Esophacoil and the Ultraflex stent [abstract].  Gastrointest Endosc. 2001;  53 AB 154
• 25 Tringali A, Mutignani M, Shah S, et al. Endoscopic palliation of esophageal strictures: preliminary results with a self-expanding plastic stent [abstract].  Gastrointest Endosc. 2001;  53 AB 149
• 26 Fregonese D, Monica F. A new treatment of upper esophageal malignant strictures using tracheal metal stents: a report on 14 cases [abstract].  Gastrointest Endosc. 2001;  53 AB 151
• 27 Yoo B M, Park J J, Choi M K, et al. A new design of covered self-expanding metal stent resistant to migration [abstract].  Gastrointest Endosc. 2001;  53 AB 155
• 28 George S J, Sharma P, Weston A P. Incidence of esophageal metallic stent induced complications and their endoscopic management [abstract].  Gastrointest Endosc. 2001;  53 AB 149
• 29 Nishikawa Y, Tajiri H, Endo H, et al. Significance and problems of self-expanding metal stents for esophageal cancer after chemoradiotherapy [abstract].  Gastrointest Endosc. 2001;  53 AB 156
• 30 Ribeiro A C, Beejay U, de la Mora G, et al. Does esophageal dilation increase the rate of metal stent migration in esophageal cancer? [abstract].  Gastrointest Endosc. 2001;  53 AB 156
• 31 Dumot J A, Zuccaro G Jr, Vargo J J, et al. Quality-of-life in palliation of esophageal cancer with photodynamic therapy (PDT) vs. self-expanding metal stents (SEMS): preliminary results of a randomized, clinical trial [abstract].  Gastrointest Endosc. 2001;  53 AB 142
• 32 Horneaux d e, Sakai P, Cecconello I, et al. Palliative treatment of esophageal cancer in whom an isoperistaltic esophagogastric bypass and autoexpandable metal stent [abstract].  Gastrointest Endosc. 2001;  53 AB 150
• 33 Kuryan A, Axelrod R, Macdonald J, et al. Neoadjuvant Nd:YAG laser therapy for esophageal cancer: immediate and long term outcomes [abstract].  Gastrointest Endosc. 2001;  53 AB 141
• 34 Mizumoto Y, Matsuda K, Watanabe T, et al. Usefulness of covered metallic stent in the patients with gastroduodenal stenosis [abstract].  Gastrointest Endosc. 2001;  53 AB 217
• 35 Taguchi A, Kato K, Morita K, et al. New technique using Ultraflex metallic stent for malignant stenosis of the stomach and duodenum [abstract].  Gastrointest Endosc. 2001;  53 AB 220
• 36 Pfau P R, Pham H, Das A, et al. A novel use of endoscopic clips in the treatment planning for radiation therapy (XRT) for esophageal cancer [abstract].  Gastrointest Endosc. 2001;  53 AB 153
• 37 Suzuki Y, Aoki T, Kawasaki Y, et al. Medical strategy to gastrointestinal obstruction in non-surgical non-curative advanced cancer: outcome of PEE and octreotide [abstract].  Gastrointest Endosc. 2001;  53 AB 204