Treatment of esophageal and gastric tumors.

In the diagnosis of early cancer, there are differences in the pathological criteria used by Western and Asian (Japanese) pathologists. The Vienna classification advocated by pathologists offers standard pathological criteria common to all endoscopists, and it has clarified the indications for the treatment of superficial lesions, including high-grade dysplasia and mucosal cancer. Endoscopic mucosal resection (EMR) is increasingly being used in the treatment of early cancer. Experience with EMR in the treatment of Barrett's esophagus with cancer has been reported, and the preliminary results are encouraging. Some technical variations and improvements in EMR procedures have been described. As an injection agent, the use of mucinous substances such as sodium hyaluronate has been reported. A cutting knife with an insulated tip has been designed, making the use of the precutting technique much safer. Studies have been conducted comparing the freehand technique with the cap technique for EMR, and it was found that the cap technique is generally better. Ablative treatment has also been used in many cases, with satisfactory results. In advanced cancer, self-expanding metallic stents have been used for palliative treatment, with generally satisfactory results. The range of applications for therapeutic endoscopy has continued to expand during the last two years in the treatment of esophageal and gastric tumors.