Endoscopic screening and surveillance for gastrointestinal malignancy.

Area of Science:

• Gastroenterology
• Oncology
• Preventive Medicine

Background:

• Upper gastrointestinal cancers have a low lifetime risk (<1%) and are rarely curable, even when detected early.
• Premalignant conditions for upper GI cancers are uncommon.
• Lower gastrointestinal cancers have a higher lifetime risk (5%), with common premalignant lesions and good curability when detected early.

Purpose of the Study:

• To evaluate the justification for endoscopic screening of the upper gastrointestinal tract in asymptomatic individuals.
• To identify conditions warranting surveillance for upper gastrointestinal cancer.
• To assess the role of lower gastrointestinal screening and surveillance in asymptomatic adults and those at increased risk.

Main Methods:

• Review of epidemiological data on upper and lower gastrointestinal cancer risks.
• Analysis of the efficacy and practicality of endoscopic screening methods.
• Identification of specific premalignant conditions and risk factors for surveillance.

Main Results:

• Endoscopic screening of asymptomatic individuals for upper gastrointestinal cancer is not justified.
• Surveillance may benefit individuals with specific uncommon conditions like Barrett's esophagus or chronic atrophic gastritis.
• Flexible sigmoidoscopy and colonoscopy are recommended for surveillance in specific high-risk groups for colorectal cancer.

Conclusions:

• Screening asymptomatic individuals for upper GI cancers is not recommended.
• Targeted surveillance for specific high-risk conditions in both upper and lower GI tracts is advised.
• Lower GI cancer screening and surveillance are more justifiable due to higher risk and curability.