Endoscopic identification of esophageal involvement by carcinoma of the stomach

Correlation between esophagoscopic findings of the lower esophagus and cardia and the extent of esophageal involvement by carcinoma of the stomach was studied in 67 patients operated upon for adenocarcinoma involving the cardia. Of 44 patients with such endoscopic signs as a mass, with or without ulceration, mucosal elevation or thickened folds in the lower esophagus, 43 had carcinomatous invasion over 1 cm. from the esophagogastric mucosal junction. On the other hand, only two of 23 patients without those endoscopic signs had esophageal involvement more than 1 cm. above the junction line. When the cardial orifice was stenotic or asymmetrically open, minimal esophageal involvement was noted in 10 patients. No tumorous invasion to the esophagus was seen in 13 patients with symmetrically open cardia. It seems appropriate to state that when endoscopic examination reveals signs suggestive of esophageal involvement by carcinoma of the stomach, thoracotomy should be performed to attain radical operation. This is so except for those with minimal carcinomatous involvement of the lower esophagus.