JLE

Hépato-Gastro & Oncologie Digestive

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Endoscopic management of superficial esophageal cancers in 2024 Volume 31, issue 1, January 2024

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Authors
1 CHU Nantes, Institut des Maladies de l’Appareil Digestif, 1 place Alexis Ricordeau, 44 000 Nantes
2 Hôpitaux Universitaires de Genève, Service d’HGE, rue Gabrielle-Perret-Gentil 4, 1211 Genève 14
3 Hôpital Cochin, service de gastro-entérologie et oncologie digestive, 27 rue du Faubourg Saint-Jacques, 75014 Paris – Université de Paris Cité
4 Centre Hospitalier Saint-Nazaire, Service d’hépato-gastro-entérologie, 11 boulevard Georges Charpak, 44600 Saint-Nazaire
* Correspondance : N. Chapelle

Esophageal cancer, comprising two histological types, adenocarcinoma and squamous cell carcinoma, has a poor prognosis because it is frequently diagnosed at advanced stage. In contrast, survival of patients with superficial cancer is excellent. Improvement of endoscopic devices (high-definition, chromoendoscopy, zoom) and the development of new endoscopic classification has significantly improved the ability to detect and characterize esophageal lesions. Endoscopic treatments are now recognized as the gold standard treatment for superficial esophageal cancers, with an excellent curative resection rate, and a lower morbidity compared to surgery. For superficial tumors, in the absence of ulceration, or stricturing lesion, en-bloc “staging” resection can be proposed. Pathology will define the curative nature of the resection. In case of a non-curative resection, rescue treatment (surgery, radiotherapy or radiochemotherapy) may be proposed. Digestive endoscopy has a major role in the management of Barrett’s esophagus to prevent adenocarcinoma and limit the risk of metachronous cancer after curative resection. Artificial intelligence should play an important role in the detection and characterization of esophageal lesions in the future, but has not been validated in clinical practice, yet.