The role of endoscopy in the assessment and treatment of esophageal cancer

Esophageal cancer carries significant morbidity and mortality. Endoscopy is pivotal in the diagnosis and management of this malignancy. Multiple biopsies and brushings should be obtained from suspicious lesions (B). EUS provides accurate staging that is superior to CT scanning (A) and allows for stage-directed therapy (C), which may improve outcome and reduce costs (B). The majority of patients will not be cured and will require palliation. Endoscopic palliation of dysphagia may be achieved with bougienage, tumor ablation, or placement of a stent. Bougienage results in short-lived palliation (B). Tumor ablation can be achieved with alcohol injection, laser, or PDT, with similar efficacy among these techniques (A). Expandable metal stents are superior to plastic stents (A). Choice among the palliative techniques will be determined by tumor characteristics, patient preferences, and local expertise.