Role of Endoscopy in the Diagnosis and Management of Esophageal Cancer

Esophageal cancer cases are predicted to reach 957,000 by 2040. Prior mortality rates average 6.5% in men and 2.2% in women, with a poor 5-year prognosis of 20%. A deficiency in screening guidelines, an incomplete understanding of pathophysiology, and limited treatment options contributed to this poor prognosis. Now, as technology and knowledge evolve, endoscopy serves a primary role in improving morbidity and mortality around esophageal cancer, in which early detection and treatment play a profound role. Advances in diagnostic modalities, including higher frequency ultrasound, acquisition of larger specimens, and nodal characterization, all improve esophageal cancer diagnostic accuracy and treatment planning. This is primarily due to earlier detection of precursor lesions, eradication with complete resection, and more informed surveillance. Prior management with esophagectomy has now evolved to include endoscopic submucosal dissection, mucosal resection, ablation, stent placement, fiducial markers for radiotherapy, sponge vacuum, and more. These endoluminal remedies are curative, palliative, or post-intervention solutions, thereby reducing the surgical risk, morbidity, and mortality associated with esophageal cancer. This review article details the diagnostic and therapeutic role of endoscopy in esophageal cancer.