Diagnostic and therapeutic endoscopy

Within the gastrointestinal tract, there is no shorter segment with a higher cancer incidence than the gastro-esophageal junction. Flexible endoscopy is the mainstay for diagnosis of early and advanced esophageal adenocarcinoma, for the treatment of early lesions, and also for the palliation of advanced cancer. New developments in endoscopy aim to improve the diagnosis and treatment of esophageal cancer. These include high resolution and magnification endoscopy in combination with chromendoscopy, and techniques based on modulation of the features of light bundles, such as narrow band imaging, fluorescence endoscopy, and elastic scattering spectroscopy. The value of these techniques for the surveillance of distal esophageal neoplasia needs further study. Furthermore, new methods of tissue sampling and evaluation are being studied to augment identification and staging of patients at risk for cancer. Finally, newer instruments may decrease patient burden during endoscopy, making screening and surveillance more acceptable from a patient's perspective. This review discusses the new developments in flexible endoscopy for diagnosis and therapy of early and advanced and advanced esophageal adenocarcinoma.