Endoscopy in gastric malignancy

Gastric cancer remains, in most parts of the world, a disease of advanced presentation and associated resistantly high mortality. To date, fiberoptic endoscopy has yet to change this seemingly inexorable fact. Nevertheless, endoscopy plays a vital role in the evaluation and diagnosis of the gastric cancer patient and provides palliative options to patients suffering from advanced disease that may not respond to other modalities. With the advent of endoscopic screening protocols identifying cases at an early stage, there is early epidemiologic evidence of impact on the mortal consequences of this disease in high incidence areas such as Japan. Endoscopic ultrasound, flow cytometry of endoscopic biopsies, and photodynamic techniques offer the prospect of increasing definition of gastric malignancy prior to therapy, and new endoscopic therapies await further study to define their potential role in treating early cancer non-operatively. Twenty years ago, scientists intent on the study of gastric neoplasia played a major role in the advent of fiberoptic endoscopy. To date, their reward has been a wealth of information. As this material is digested and applied, it seems reasonable to believe their efforts may be eventually rewarded by a reduction in the epidemiologic impact of this disease, brought about not by changing global incidence patterns, but by knowledge and technology derived and administered endoscopically.