Esophageal Cancer Awareness Issue 2019

Peter D. Siersema

April 2019 marks the 10th annual Esophageal Cancer Awareness Month. Esophageal cancer is one of the fastest-growing cancer diagnoses in the Western world and is the seventh most commonly occurring cancer in men and 13th most common in women [1]. Although squamous cell carcinoma (SCC) is the dominant subtype of esophageal cancer in central Asia and southern Africa, esophageal adenocarcinoma is the increasingly common subtype in Western Europe and the US.

Esophageal cancer is often diagnosed at a late stage, and it is therefore important to recognize its precursor lesions, which in the case of adenocarcinoma is Barrett’s esophagus. Recognizing patients with Barrett’s esophagus and inviting them to undergo regular surveillance can detect dysplasia and early cancer. In such cases endoscopic treatment is often possible, preventing the development of advanced stages of esophageal cancer.

This year, for the first time, Endoscopy has devoted most of its April issue to Esophageal Cancer Awareness Month. In this issue, Endoscopy presents important new research on the diagnosis of early stage esophageal SCC and Barrett’s esophagus, the endosonographic detection of residual disease after neoadjuvant chemoradiotherapy (nCRT) for esophageal cancer, and the endoscopic treatment of early stage SCC and dysplasia in Barrett’s esophagus. Finally, research is presented on the endoscopic treatment of nonmalignant esophageal disease, that is, achalasia and esophageal diverticula.

Three studies investigate novel methods for the detection of neoplasia in the esophagus. One pilot study from Boston shows that ultrahigh-speed endoscopic optical coherence tomography (OCT) has the potential for detecting dysplasia in Barrett’s esophagus. Another pilot study from China concludes that detachable string magnetically controlled capsule endoscopy (DS-MCE) is safe and well-tolerated for viewing the esophagus, and may be useful for screening groups at risk of developing esophageal cancer. In the third study, also from China, the accuracy of computer-assisted diagnosis of esophageal SCC is shown to be similar to that of experienced endoscopists and better than that of the less experienced.

A study from the Netherlands shows that endoscopic ultrasound (EUS) measurements of residual thickness and residual area after nCRT for esophageal cancer can be used for restaging, and potentially to select patients who do not require esophageal resection after a complete response from nCRT.

Two studies discuss endoscopic treatment of early esophageal cancer. In the first, from France, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) of superficial esophageal SCC is found to be safe and efficient in European hands. As ESD is associated with increased recurrence-free survival rates, it should in many cases be preferred over EMR. A study from Belgium demonstrates that radiofrequency ablation in combination with endoscopic resection is also an efficient treatment for Barrett’s esophagus with dysplasia or early adenocarcinoma; this is in the absence of reimbursement.

Regarding nonmalignant esophageal disease, achalasia is the common denominator of three studies in this issue. A study from China shows that peroral endoscopic myotomy (POEM) can be performed safely with a low rate of major adverse events in achalasia patients with prior surgical or endoscopic treatment of achalasia. Another pilot study suggests that POEM is also safe and efficient in patients with prior Roux-en-Y gastric bypass anatomy. Remarkably, the risk of gastroesophageal reflux disease in these patients seems minimal after POEM. In a third pilot study from Mexico, it is shown that POEM using a small-caliber endoscope (“thin-POEM”) is safe, effective, and minimally invasive in patients with achalasia.

An international pilot study shows that endoscopic management of esophageal diverticula using diverticular POEM (D-POEM) appears promising and ensures complete septotomy, but larger studies are needed to confirm the results.

A joint updated guideline from the European Society of Gastrointestinal Endoscopy (ESGE), the European Helicobacter and Microbiota Study Group (EHMSG), the European Society of Pathology (ESP), and the Sociedade Portuguesa de Endoscopia Digestiva (SPED) completes this issue, providing guidance on the management of epithelial precancerous conditions and lesions in the stomach.

We hope you will enjoy reading about the latest developments in the diagnosis and treatment of premalignant changes and early cancer in the esophagus, but also about the treatment of nonmalignant esophageal disorders, in this 2019 Esophageal Cancer Awareness Month issue.

Peter D. Siersema
on behalf of the Editors

• References

• 1 World Cancer Research Fund. https://www.wcrf.org/dietandcancer/cancer-trends/oesophageal-cancer-statistics. Accessed: 19 Feb 2019