ENDOSCOPIC DIAGNOSIS OF ADENOCARCINOMA OF THE ESOPHAGOGASTRIC JUNCTION

Abstract

Adenocarcinoma of the esophagogastric junction (EGJ) includes both esophageal cancer and gastric cancer whose center is located in the EGJ. The incidence of EGJ adenocarcinoma has increased sharply in the past 30 years in the United States and European countries, and has shown a gradual increase in Japan. Because the infectious rate of Helicobacter pylori in Japan has decreased and our eating habit has become westernized, the incidence of gastroesophageal reflux disease has increased in Japan. Thus, it is estimated that the incidence of EGJ adenocarcinoma in Japan will also increase in the near future.

When we differentiate T1 EGJ adenocarcinoma into two types according to the presence of endoscopic mucosal atrophy, lesions were located above and in the upper-right of the EGJ in cases without mucosal atrophy, whereas lesions were located below the EGJ in cases with mucosal atrophy. For the cases that were treated with endoscopic submucosal dissection, although en-bloc resection rates were 100% in both Barrettʼs esophageal cancer and gastric fundic cancer, the curative resection rate in Barrettʼs esophageal cancer cases was significantly lower than that in gastric fundic cancer cases, indicating the difficulty in diagnosing the depth of invasion of Barrettʼs esophageal cancer.

To detect Barrettʼs esophageal cancer, it is recommended that endoscopists ask patients to take a deep breath to extend the wall of the EGJ and observe the upper and right wall, where EGJ adenocarcinoma is frequently detected. Acetic acid which emphasizes the microstructure and magnifying endoscopy with narrow band imaging (NBI) were reported to increase the accuracy of diagnosing dysplasia.