Gastrointestinal Endoscopy in the Cancer Patient E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 1079

Veröffentlichungsjahr: 2013

Beschreibung

This book is a full colour, highly clinical multi-media atlas focusing on the role diagnostic and therapeutic endoscopy plays in the management of patients with cancer. Conveniently split into sections for each part of the GI tract, each section will follow a consistent structure. With 400 high-quality images and in addition, 21 high-definition videos showing endoscopy from the experts, this book is the perfect consultation and learning tool for all gastroenterologists, endoscopists, GI surgeons and oncologists.

Leseprobe

Contents

Cover

Companion website

Title Page

Copyright

List of Contributors

1 Introduction to Endoscopy

Chapter 1: Introduction to Gastrointestinal Endoscopy in the Cancer Patient

Reference

2 Esophagus

Chapter 2: Staging of Premalignant and Malignant Conditions of the Esophagus

Introduction

Benign lesions

Esophageal adenocarcinoma

Squamous cell dysplasia and carcinoma

Malignant melanoma of the esophagus

Small cell cancer of the esophagus

References

Chapter 3: Endoscopic Management of Premalignant and Early Malignant Diseases of the Esophagus

Introduction

Endoscopic resection

Field ablation

Subsquamous specialized intestinal metaplasia

Summary

References

Chapter 4: Palliation of Advanced Tumors of the Esophagus Including YAG Laser, APC, PDT, Ethanol, Stent for Obstruction or Fistula, PEG, and Brachytherapy

Introduction

Nd:YAG laser

Argon plasma coagulation

Photodynamic therapy

Ethanol injection therapy

Stents for obstruction or fistula

Percutaneous endoscopic gastrostomy

Brachytherapy

Conclusions and future directions

References

Chapter 5: Endoscopy in Esophageal Cancer: An Oncologist’s Perspective

Introduction

Preoperative staging

Treatment

Perspectives

References

3 Stomach

Chapter 6: Diagnosis and Staging of Diseases of the Stomach

Introduction

Description of EGC

Endoscopic diagnosis of EGC

Endoscopic staging of invasion depth

Correlations between macroscopic type and invasion depth

Endoscopic ultrasonography

Depth predictive score

Conclusions

Acknowledgments

References

Chapter 7: Endoscopic Management of Premalignant and Early Malignant Lesions

Endoscopic treatment

History of endoscopic treatment

Indications for endoscopic resection

Details of the techniques

Management of during and after endoscopic resection

Training

Current technology and future expectation

References

Chapter 8: Palliation of Advanced Tumors of the Stomach

Introduction

Endoscopic stent placement

Laser therapy

Photodynamic therapy

Argon plasma coagulation

Injection of alcohol and cytotoxic agents

Conclusion

References

Chapter 9: Gastroscopy in Gastric Cancer: An Oncologist’s Perspective

Introduction

Neoadjuvant chemoradiotherapy

Neoadjuvant chemotherapy

Adjuvant chemoradiation

Adjuvant chemotherapy

Targeted biological therapy

Phase 3 trials of cytotoxic chemotherapy for metastatic gastric cancer

Molecular signatures for gastric cancer

Conclusions

References

4 Small Bowel

Chapter 10: Staging of Premalignant and Early Malignant Diseases of the Small Bowel

Introduction

Diagnostic imaging

Conditions predisposing to neoplasms in the small intestine

Lymphoma

Adenoma and adenocarcinoma

Gastrointestinal stromal tumor

Neuroendocrine tumors (carcinoid)

Metastatic tumor

Hamartoma

Mesenchymal tumors

Other types of potentially benign tumors

References

Chapter 11: Endoscopic Management of Premalignant, Early, and Advanced Malignancies of the Small Bowel

Introduction

Summary

References

Chapter 12: The Role of Endoscopy in Small Bowel Malignancies

Introduction

Epidemiology of small bowel malignancies

Clinical presentation of small bowel cancers

Predisposing/premalignant conditions for small bowel malignancies

Endoscopic management of small bowel malignancy

Endoscopic approaches to the distal small bowel

Indications for endoscopic examination of the small bowel

Endoscopic approaches to enteral nutrition

References

5 Pancreatic

Chapter 13: Diagnosis and Staging of Pancreatic Neoplasms

Introduction

Pancreatic adenocarcinoma

Endoscopic ultrasound

Endoscopic ultrasound with fine needle aspiration

EUS staging

Multidetector CT and PET scan

MRI/magnetic resonance cholangiopancreaticography

Endoscopic retrograde cholangiopancreatography

Pancreatic neuroendocrine tumors (PNET)

Diagnosis of pancreatic neuroendocrine tumors

Other pancreatic malignancies

References

Chapter 14: Pancreatic Cystic Lesions

Introduction

Epidemiology

Pancreatic cystic lesions

Diagnostic evaluation of pancreatic cystic lesions

Management

References

Chapter 15: Pancreatic Cancer Screening in High-Risk Individuals

Introduction

Principles of pancreatic cancer screening

Who is at increased risk of developing pancreatic cancer?

Genetic counseling and testing

Screening strategies in high-risk patients for pancreatic cancer

Data on screening strategies

Proposed screening strategy

Summary

References

Chapter 16: Endoscopic Palliation of Pancreatic Cancer

Introduction

Biliary obstruction

Duodenal obstruction

Abdominal pain

Steatorrhea

Gastrointestinal bleeding

Postsurgical complications

Summary

References

Chapter 17: Endoscopy in Pancreatic Cancer: An Oncologist’s Perspective

Introduction

A multidiscipline team to care for patients with pancreatic cancer

Risk factors

Screening

Presentation to oncology

Pathology study and implications for treatment

Celiac plexus block and biliary stent placement

Intratumoral treatment of pancreatic cancer

Intraductal papillary mucinous neoplasms and mucinous cystic neoplasms

Nutritional support with gastroduodenal stent

Summary

References

6 Gallbladder, Bile Duct, and Ampulla of Vater Biliary, Gallbladder, and Ampullary Lesions

Chapter 18: Diagnosis and Staging of Premalignant and Early Malignant Diseases

Introduction

Ampullary lesions

Extrahepatic biliary tree

Gallbladder lesions

Conclusions

References

Chapter 19: Management of Premalignant and Early Malignancies of the Bile Ducts and Ampulla

Introduction

Choledochal cysts and choledochoceles

Bile duct adenomas

Ampullary adenomas

Nonadenomatous ampullary tumors

Conclusion

References

Chapter 20: Palliation of Advanced Tumors

Endoscopic versus surgical management of malignant biliary obstruction

Endoscopic versus percutaneous transhepatic stenting

Palliative endoscopic stenting in malignant biliary obstruction

Photodynamic therapy

Management of SEMS occlusion

Future perspectives

References

Chapter 21: Endoscopy in Biliary Tract Cancers: An Oncologist’s Perspective

Introduction

Future perspectives

Acknowledgements

References

7 Hepatic Tumors (Including Intrahepatic Cholangiocarcinoma)

Chapter 22: Diagnosis and Staging of Premalignant and Malignant Diseases of the Liver

Introduction

Diagnosis and staging of premalignant diseases of the liver

Diagnosis and staging of HCC

Diagnosis and staging of premalignant diseases of the bile duct

Diagnosis and staging of CCA

Other premalignant and malignant diseases of the liver

References

Chapter 23: Endoscopic Evaluation and Therapy for Complications of Cirrhosis

Upper gastrointestinal bleeding in cirrhosis

General concepts about AVH

Emergent management of AVH

Prevention of complications and deterioration of liver function

Ascites and renal function

Emergent treatments for AVH

Secondary prevention of recurrent AVH

Prevention of first AVH: primary prophylaxis for AVH

Management of other portal HTN etiologies for bleeding: variceal and nonvariceal

Mucosal bleeding sources with portal hypertension

Conclusions

References

Chapter 24: Endoscopic Management of Early and Advanced Hepatic Tumors

Introduction

Intrahepatic cholangiocarcinoma

Endoscopic interventions

Biliary drainage

Endoscopic stenting

Cholangitis complicating ERCP

Percutaneous and combined drainage

EUS guided drainage

Endoscopic guided local destructive therapy

Drug-eluting stent

Cholangioscopy

Endoscopic brachytherapy

Endoscopic treatment in HCC

Conclusion

References

Chapter 25: Hepatic Tumors: An Oncologist’s Perspective

Oncological management of hepatocellular cancer

The oncological management of cholangiocarcinoma

The management of colorectal cancer with hepatic metastases

Conclusion

References

8 Colorectal and Anal Tumors

Chapter 26: Diagnosis, Staging, and Management of Premalignant and Early Malignant Diseases of the Colon

Endoscopic detection of neoplastic lesions

Hyperplastic polyps and sessile serrated lesions

Growth morphology and histology

Electronic enhancement of mucosal views

Endoscopic submucosal dissection

Complications of endoscopic therapy

References

Chapter 27: Palliation of Advanced Tumors

Introduction

Colonic stenting

Laser therapy in the management of obstruction

Endoscopic management of nonobstructive complications of colorectal malignancy

References

Chapter 28: Colorectal and Anal Tumors: An Oncologist’s Perspective

Colorectal cancer

Endoscopic palliation

Post-treatment surveillance

Special populations

Anal cancer

Summary

References

Chapter 29: Anal Cancer

Anal intraepithelial neoplasia

Invasive anal cancer

Acknowledgment

References

9 Gastrointestinal Endoscopic Management of Tumors Not of GI Origin–Role of GI Endoscopy

Chapter 30: Endoscopy in Hematologic Malignancies

Introduction

How safe is endoscopy in the myelosuppressed patient?

Neutropenic enterocolitis

Chemotherapy-induced alimentary mucositis

Gastrointestinal graft-versus-host disease

Risk of thrombosis: anticoagulation in the face of thrombocytopenia

Conclusion

References

Chapter 31: Thyroid, Head, and Neck Tumors

Anatomy

Nutrition

Acknowledgment

References

Chapter 32: Prostate Cancer, Ovarian, and Peritoneal Disease

Endoscopic ultrasonography

Endoscopic management of radiation proctopathy

Venting PEGS in extraluminal malignant bowel obstruction

Colonic stenting for extrinsic peritoneal compression

References

Chapter 33: Lung Cancer and Mediastinal Tumors

EUS-guided biopsy in bronchopulmonary disease

EUS-FNA for diagnosis and staging of lung cancer

EUS-FNA in non-lung cancer

EBUS and EBUS-TBNA for bronchopulmonary diseases

EBUS-TBNA for diagnosis and staging of lung cancer

EBUS-TBNA in non-lung cancer

Combined EUS-FNA and EBUS-TBNA for staging of lung cancer

References

Chapter 34: Role of GI Endoscopy in Lymphoproliferative Disorders

Background

Endoscopy and GI lymphomas

Esophageal lymphoma

Gastric lymphoma

Lymphoma of the small intestine and colon

Posttransplant lymphoproliferative disorders

Conclusion

References

Chapter 35: Endoscopy and Radiation Therapy

Introduction

EUS guided brachytherapy

EUS guided fiducial placement

Radiation-induced strictures

Radiation proctitis

Radiation-induced hepatobiliary complications

Conclusion

References

Chapter 36: Endoscopic Complications

Introduction

Generic complications

Complications of specific techniques

Prevention of complications—the endoscopist

References

Index

Companion website

This book is accompanied by a website:

www.wiley.com/go/deutsch/endoscopycancer

The website includes:

21 videos showing procedures described in the bookAll videos are referenced in the text where you see this logo

This edition first published 2013 © 2013 by John Wiley & Sons, Limited.

Wiley-Blackwell is an imprint of John Wiley & Sons, formed by the merger of Wiley’s global Scientific, Technical and Medical business with Blackwell Publishing.

Registered office: John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK

Editorial offices: 9600 Garsington Road, Oxford, OX4 2DQ, UK The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 111 River Street, Hoboken, NJ 07030-5774, USA

For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell

The right of the author to be identified as the author of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher.

Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought.

The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by physicians for any particular patient. The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. Readers should consult with a specialist where appropriate. The fact that an organization or Website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make. Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read. No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom.

Library of Congress Cataloging-in-Publication Data

Gastrointestinal endoscopy in the cancer patient / edited by John C. Deutsch, Matthew R. Banks. p. ; cm. Includes bibliographical references and index. ISBN 978-0-470-67246-4 (hardback : alk. paper) I. Deutsch, John C. II. Banks, Matthew R. [DNLM: 1. Digestive System Neoplasms--diagnosis. 2. Endoscopy, Digestive System. 3. Digestive System Neoplasms--therapy. 4. Neoplasm Staging. 5. Palliative Care. WI 149] 616.99′4307545--dc23 2012037015

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Cover image: Courtesy of John C. Deutsch

List of Contributors

Seiichiro Abe MD Endoscopy Division National Cancer Center Hospital Tokyo, Japan

Douglas G. Adler MD, FACG, FASGE, AGAF Division of Gastroenterology and Hepatology Huntsman Cancer Institute University of Utah School of Medicine Salt Lake City, UT, USA

Vipul Aggarwal MBBS, FRACP Department of Gastroenterology Royal North Shore Hospital Sydney, NSW, Australia

Jouke Annema MD, PhD Department of Pulmonology Academic Medical Center Amsterdam, The Netherlands

Muslim Atiq MD Sanford Health Sanford-USD School of Medicine Sioux Falls, SD, USA

Matthew R. Banks FRCP, PhD University College London Hospitals NHS Trust London, UK

Manoop S. Bhutani MD, FACG, FASGE, FACP, AGAF Department of Gastroenterology, Hepatology, and Nutrition UT MD Anderson Cancer Center Houston, TX, USA

Stephen Bown MD, FRCP Department of Gastroenterology University College London Hospitals NHS Foundation Trust London; and National Medical Laser Centre University College London London, UK

Maria Ignez F. Melro Braghiroli MD Clinical Oncology Instituto do Cåncer do Estado de São Paulo São Paulo, Brazil

John Bridgewater MD, PhD UCL Cancer Institute London, UK

Alexa Childs MA, MB, BChir Department of Oncology UCL Medical School London, UK

Paul Clementsen MD, DMSc Department of Pulmonary Medicine Gentofte Hospital University of Copenhagen Copenhagen, Denmark

Gregory A. Coté MD, MS Division of Gastroenterology Indiana University School of Medicine Indianapolis, IN, USA

Gilberto de Castro Junior MD, PhD Clinical Oncology Instituto do Cåncer do Estado de São Paulo São Paulo, Brazil

Alexander Dekovich MD Department of Gastroenterology, Hepatology and Nutrition UT MD Anderson Cancer Center Houston, TX, USA

John C. Deutsch MD Essentia Health Systems Duluth, MN, USA

John M. DeWitt MD Indiana University School of Medicine Indianapolis, IN, USA

Jeffrey Dunkelberg MD, PhD Division of Gastroenterology–Hepatology University of Iowa Health Care Iowa City, IA, USA

J.M. Dunn BSc, PhD, MRCP National Medical Laser Centre, University College London London, UK; and Institute of Medical Informatics, Oslo University Hospital Oslo, Norway

Ihab I. El Hajj MD, MPH Indiana University School of Medicine Indianapolis, IN, USA

Imad Elkhatib MD Division of Gastroenterology University of California–San Diego San Diego, CA, USA

Elizabeth Fallon MD Division of Gastroenterology–Hepatology University of Iowa Health Care Iowa City, IA, USA

Syed M. Abbas Fehmi MD, MSc Division of Gastroenterology University of California–San Diego San Diego, CA, USA

Lucia C. Fry MD, PhD, FASGE Department of Gastroenterology, Hepatology and Infectious Diseases Marienhospital Bottrop Otto-von-Guericke University Magdeburg, Germany

Takahiro Fujii MD, PhD Endoscopy Division National Cancer Center Hospital Tokyo, Japan

Ingrid Gonzalez MD Division of Gastroenterology University of California–San Diego La Jolla, CA, USA

Takuji Gotoda MD, PhD Department of Gastroenterology and Hepatology Tokyo Medical University Tokyo, Japan

Jonathan R.B. Green MA, DM, FRCP Gastroenterology Department University Hospital of North Staffordshire Stoke on Trent, UK

Rehan J. Haidry MD National Medical Laser Centre, University College London Department of Gastroenterology University College London Hospitals NHS Trust London, UK

Daniel Hochhauser MA (Cantab), DPhil, FRCP UCL Cancer Institute and University College London Hospital London, UK

Frederick Johlin MD Division of Gastroenterology–Hepatology University of Iowa Health Care Iowa City, IA, USA

Gavin J. Johnson MSc, MD, MRCP Department of Gastroenterology University College London Hospitals NHS Foundation Trust London, UK

Evangelos Kalaitzakis MD, PhD Department of Gastroenterology Skåne University Hospital Lund, Sweden

Tonya Kaltenbach MD, PhD Veterans Affairs Palo Alto Palo Alto, CA Stanford University School of Medicine Stanford, CA, USA

David Kim MD Department of Radiology University of Wisconsin Hospital and Clinics Madison, WI, USA

Hiroto Kita MD Department of Gastroenterology International Medical Center Saitama Medical University Saitama, Japan

Lars Konge MD, PhD Centre for Clinical Education University of Copenhagen and the Capital Region of Denmark Copenhagen, Denmark

Fa-Chyi Lee MD University Health Science Center Albuquerque, NM, USA

Yuk Tong Lee MD, FRCP Institute of Digestive Disease The Chinese University of Hong Kong Prince of Wales Hospital Shatin, New Territories, Hong Kong

Sam J. Lubner MD University of Wisconsin Carbone Cancer Center University of Wisconsin Hospital and Clinics Madison, WI, USA

Lisa Madlensky PhD, CGC Department of Family and Preventive Medicine University of California, San Diego Moores UCSD Cancer Center La Jolla, CA, USA

Jayan Mannath MD, MRCP Department of Gastroenterology University Hospitals Coventry and Warwickshire NHS Trust Coventry, UK

Peter R. McNally DO, MSRF, MACG Department of Gastroenterology Evans Army Medical Center Colorado Springs, CO, USA

P. Alexander McNally MD Department of Surgery University of Colorado Denver Aurora, CO, USA

Joshua Melson MD Division of Digestive Diseases Department of Internal Medicine Rush University Medical Center Chicago, IL, USA

Tim Meyer FRCP, PhD UCL Cancer Institute and Royal Free Hospital London, UK

Klaus E. Mönkemüller MD, PhD, FASGE Basil Hirschowitz Unit of Endoscopic Excellence Division of Gastroenterology University of Alabama at Birmingham Birmingham, AL, USA

Craig A. Munroe MD Division of Gastroenterology University of California–San Diego San Diego, CA, USA

Geetha Nallamothu MD St. Marks Medical Center Salt Lake City, UT, USA

Helmut Neumann MD, PhD Department of Gastroenterology Friedrich-Alexander-University Nürnberg, Germany

Ian D. Norton MBBS, PhD, FRACP, FASGE Department of Gastroenterology Royal North Shore Hospital Sydney, Australia

Ichiro Oda MD Endoscopy Division National Cancer Center Hospital Tokyo, Japan

Abhitabh Patil MD Rush University Division of Digestive Diseases Department of Internal Medicine Rush University Medical Center Chicago, IL, USA

Bjorn Rembacken MB, ChB, MD, FRCP Endoscopy Division National Cancer Center Hospital Tokyo, Japan

Camille Rodrigues da Silva MD Research & Development Department Eurofarma Laboratórios S.A. Sao Paulo, Brazil

William A. Ross MD Department of Gastroenterology, Hepatology and Nutrition MD Anderson Cancer Center Houston, TX, USA

Mohammed H. Saad MD Division of Gastroenterology Department of Internal Medicine American University of Beirut Medical Center Beirut, Lebanon

Thomas J. Savides MD Division of Gastroenterology University of California, San Diego La Jolla, CA, USA

Stefan Seewald MD, PhD Center of Gastroenterology Klinik Hirslanden Zurich, Switzerland

David Shapiro MD Rush University Division of Digestive Diseases Department of Internal Medicine Rush University Medical Center Chicago, IL, USA

Peter D. Siersema MD, PhD, FASGE, FACG Department of Gastroenterology and Hepatology University Medical Center Utrecht Utrecht, The Netherlands

Roy Soetikno MD, PhD Veterans Affairs Palo Alto Palo Alto, CA Stanford University School of Medicine Stanford, CA, USA

Assaad M. Soweid MD, FASGE, FACG Division of Gastroenterology Department of Internal Medicine American University of Beirut Medical Center Beirut, Lebanon

Alan Stolpen MD Department of Radiology University of Iowa Health Care Iowa City, IA, USA

Joseph J.Y. Sung MD, PhD, FRCP The Chinese University of Hong Kong Prince of Wales Hospital Shatin, New Territories, Hong Kong

Raymond S. Tang MD Institute of Digestive Disease The Chinese University of Hong Kong Prince of Wales Hospital Shatin, New Territories, Hong Kong

Muhammed Thoufeeq MBBS, MRCP(UK), MRCP(Gastro) Department of Gastroenterology The General Infirmary Leeds, UK

Evelyn P.M. van Vliet MD, PhD Department of Gastroenterology and Hepatology University Medical Center Utrecht Utrecht, The Netherlands

Peter Vilmann MD, DSc, HC Department of Surgical Gastroenterology Herlev Hospital University of Copenhagen Herlev, Denmark

Katie Weatherstone MRCP Department of Oncology UCL Medical School London, UK

George J. Webster BSc, MD, FRCP Department of Gastroenterology University College London Hospitals NHS Foundation Trust London, UK

Jennifer Weiss MD Division of Gastroenterology University of Wisconsin Hospital and Clinics Madison, WI, USA

Hironori Yamamoto MD, PhD Department of Endoscopic Research and International Education Director of Endoscopy Center Jichi Medical University Tochigi, Japan

Cheng Yeoh MBBS, BMedSc, MRCP, PhD North Middlesex University Hospital Trust London, UK

Shigetaka Yoshinaga MD, PhD Endoscopy Division National Cancer Center Hospital Tokyo, Japan

1 Introduction to Endoscopy

1

Introduction to Gastrointestinal Endoscopy in the Cancer Patient

Matthew R. Banks1 and John C. Deutsch2

1University College London Hospitals NHS Trust, London, UK2Essentia Health Systems, Duluth, MN, USA

Key points

Gastrointestinal endoscopy is important in the diagnosis and management of gastrointestinal and some non-gastrointestinal cancers.There are many types of gastrointestinal endoscopes and many devices to assist in taking biopsies, performing resections, and palliating bleeding or obstruction.

Over the last decade, endoscopy has vastly improved the diagnosis, staging, and treatment of patients with cancer affecting the gastrointestinal tract. The complexity and range of procedures now available to manage these patients has led to the development of endoscopists with expertise covering specific conditions such as hepatobiliary or esophagogastric cancers. It is of great importance to ensure that patients receive the best care. In order to achieve this, it is important to ensure that the multidisciplinary team managing patients, with not only gastrointestinal cancers, but other malignancies as well, is fully informed of all available endoscopic procedures. This book demonstrates the current endoscopic procedures available in order to manage patients with malignant and premalignant conditions of the gastrontestinal tract. It will hopefully be of benefit to endoscopists, oncologists, gastroenterologists, and surgeons, as well as all those involved in cancer patient care, both as an informative read and as a reference guide.

The current practice of gastrointestinal endoscopy generally involves placing a flexible tube with a light source, video-chip capture, and a working channel within a luminal structure of the gastrointestinal tract (Figures 1.1, 1.2, and 1.3). The image lens can be in the front, on the side perpendicular to the long axis, or in an oblique orientation of the endoscope (Figures 1.3a–1.3c).

FIGURE 1.1 A cabinet of endoscopes.

FIGURE 1.2 A radial array endoscope just before use.

FIGURE 1.3 (a) The tip of a colonoscope with forward viewing optics. (b) The tip of a duodenoscope with side viewing optics. (c) The tip of a linear array echoendoscope. (Reproduced and used with permission from Pentax Medical Company.)

Fiber optic endoscopy was first described by Hirschowitz et al. in 1957 (1). There have been many improvements in image quality since that report, and the resolution of the images obtained has been revolutionized by megapixel charged coupled devices (video-chip) and 1080p high-definition screens. This has enabled the endoscopist to visualize the mucosal architecture and vasculature in detail not imagined by the earlier investigators. Endoscopes that use different wavelengths of light or various computer-generated modifications have been developed, as seen with selected light wavelengths such as narrow band imaging (Figure 1.4) or various computer enhancements such as iScan and magnification (Figure 1.5). Further detail can be achieved with confocal laser endomicroscopy which utilizes blue laser light focused on a single horizontal level. Magnification on special instruments can be generated to 1000-fold, resulting in images at the cellular level mimicking histopathological sections. One can now appreciate changes suggesting early epithelial neoplasia.

FIGURE 1.4 (a) Esophageal gastric junction by white light. (b) The same location using narrow band imaging.

FIGURE 1.5 High-grade dysplasia and Barrett’s mucosa using ISCAN 2.

Endoscopes with ultrasound probes in the tip have been developed (Figures 1.3c and 1.6a and 1.6b) which allow visualization through the intestinal wall. Ultrasound images can be created perpendicular to or parallel to the endoscope, and needles can be placed into lesions under endoscopic guidance (Figures 1.7a and 1.7b).

FIGURE 1.6 (a) A radial array EUS endoscope with a biopsy forceps in the working channel. (Reproduced and used with permission from Pentax Medical Company.) (b) An EBUS endoscope with a needle in the working channel. (Reproduced and used with permission from Pentax Medical Company.)

FIGURE 1.7 (a) A stromal tumor visualized with radial array EUS. (b) The same lesion seen with linear array EUS during needle aspiration.

Gastrointestinal endoscopes are from 5 to 13 mm in diameter, and generally 100 to 180 cm in length. Some specialized endoscopes are shorter (such as the 60 cm endobronchial ultrasound instrument that is also used in the esophagus) and some are longer (e.g., a 220 cm small bowel enteroscope). There are instruments that are narrower, such as a 2.8 mm diameter choledochoscope or a 2 mm ultrasound miniprobe. White light is commonly used with a curved lens that gives about a 10-fold magnification, depending on the distance of the endoscope tip from the image object. Endoscopes have a hollow channel (Figures 1.3a and 1.3b and 1.6a and 1.6b) to allow the passage of various tools such as biopsy forceps, snares, clips, needles, dilators, and hemostasis devices (Figures 1.8a–1.8f). This allows biopsy, snare, closure of defects, and control of bleeding. Devices that use the outside of the endoscope as well as the internal channel to allow resection while minimizing the risk of perforation are also available (Figures 1.9a and 1.9b). Palliative therapy such as stenting to open a stricture is commonly performed. There are several types of stents and delivery devices that are available (Figures 1.10a–1.10c). Stents can be passed either through the scope or positioned with endoscopic and fluoroscopic assistance.

FIGURE 1.8 Some peripheral devices that can be used during endoscopy. (Images (a–e). Permission for use granted by Cook Medical Incorporated, Bloomington, IN.) (a) Biopsy forceps; (b) snare; (c) endoclip “Instinct Clip”; (d) EUS needle “ProCore”; (e) dilator; (f): hemospray coagulation device.

FIGURE 1.9 (a) The upper handle of a band ligation device with a snare in the working channel. “Duette Band Ligation Device.” (b) The endoscope tip of a band ligation device. Small rubber bands on the end of the endoscope are placed around a lesion creating a pseudopolyp. A snare is used to remove the pseudopolyp. “Duette Band Ligation Device.” (Images a–b. Permission for use granted by Cook Medical Incorporated, Bloomington, IN.)

FIGURE 1.10 (a) Various types of stents. (Reproduced and used with permission from Boston Scientific.) “Wallstents.” (b) Example of a stent deployment devices. (Reproduced and used with permission from Boston Scientific.) (c) Example of a stent deployment device. (Permission for use granted by Cook Medical Incorporated, Bloomington, IN.)

Capsule endoscopy is different from the usual endoscopic examination. With this method, a camera within a pill (Figure 1.11) is ingested and images are transmitted to recorders on the surface of the patient—up to 50,000 images are collected over 8 h and then reviewed as a video file.

FIGURE 1.11 Pill CAM device in package prior to use.

With the wide array of instruments and peripherals, gastrointestinal endoscopy has evolved from primarily a luminal diagnostic procedure to a procedure in which luminal and extraluminal diagnostic and therapeutic interventions are routinely performed.

Endoscopy is very important in the management of patients with premalignant and malignant conditions. Pathological diagnosis using direct visualization biopsy or by endoscopic ultrasonography-guided needle aspiration, evaluation for secondary tumor effects (bleeding, obstruction), curative therapy (endoscopic resection, thermal ablation), and palliative therapy (biliary stents, celiac block) are all part of what an endoscopist can do (Video 1.1).

The following chapters describe what endoscopists can offer in the management of patients with oncologic conditions, as well as an oncologic perspective in the management of various tumor types.

Chapter video clip

Video 1.1 The video shows a dysplastic esophageal lesion as seen under white light and then under ISCAN2.

Reference

1. Hirschowitz BI, Peters CW, Curtiss LE. Preliminary report on a long fiberscope for examination of stomach and duodenum. Med Bull (Ann Arbor). 1957;23:178–180.

2 Esophagus

2

Staging of Premalignant and Malignant Conditions of the Esophagus

Rehan J. Haidry and Matthew R. Banks

University College London Hospitals NHS Trust, London, UK

Key points

Leiomyomas are the most common intramural mesenchymal tumor of the esophagus and outnumber esophageal GISTs by two- to threefold.Granular cell tumors of the esophagus are rare and account for 0.0019–0.03% of all tumors affecting humans, and malignant transformation is rarer still.Barrett’s esophagus (BE) is the most important precursor lesion of esophageal adenocarcinoma (EAC) and it is thought that 64–86% of all EACs arise in BE.The incidence of EAC for patients with BE appears to be increased 30- to 100-fold above that for the general population.Targeted biopsies of abnormal areas in BE with optical enhancements such as narrow band imaging, iScan, and FICE are likely to improve the diagnosis of dysplasia or early cancer.In expert hands, confocal endomicroscopy has a sensitivity of 92% for the diagnosis of Barrett’s dysplasia.EUS is useful for nodal staging in early esophageal cancer but inaccurate for T-staging. EUS is the most accurate technique for T- and N-staging in advanced esophageal cancer.

Introduction

Accurate diagnosis and staging of benign and malignant lesions of the esophagus requires an in-depth understanding of current endoscopic techniques and the latest technology. The endoscopic optical technology has evolved rapidly in the last decade such that the resolution of the charge coupled device (CCD) chip is up to 1.4 million pixels. The images are further enhanced by optical filters and post image processing technology, allowing detailed views of the mucosal architecture. This, in turn, allows improved accuracy of diagnosis. We explore the roles of high-definition white light endoscopy (HD-WLE), chromoendoscopy, confocal endomicroscopy, and EUS in the diagnosis and staging of esophageal neoplasia.