CA: A Cancer Journal for Clinicians, Vol 15, 46-53, Copyright
© 1965 by American Cancer Society
The Role of Gastrointestinal Endoscopy in Gastroenterologic Cancer
Vernon M. Smith M.D., F.A.C.P.1
1 Head, Department of Medicine and Director of Gastroenterological Research, Merey Hospital, and Professor of Clinical Medicine, University of Maryland School of Medicine, Baltimore.
Modern gastrointestinal endoscopy is a valuable clinical adjunct in the detection and evaluation of gastroenterologic cancer. More than 70% of malignant tumors of the gastrointestinal tract occur within the purview of esophagoscopy, gastroscopy and sigmoidoscopy. Peritoneoscopy may reveal that abdominal cancer is inoperable, and, thereby, eliminate the need for diagnostic abdominal laparotomy. Also, the peritoneoscopic demonstration of a distended gallbladder in a jaundiced patient encourages prompt surgical intervention for the extrahepatic biliary obstruction.
At the present time, the cure of gastroenterologic cancer is implemented mainly by early diagnosis and treatment. Since the various endoscopic techniques can detect very small mucosal lesions, even before they have become symptomatic or demonstrable radiologically, these procedures should be incorporated into the diagnostic armamentarium far more than heretofore. They should be considered as readily as are diagnostic radiological procedures in clinical practice and, in selected cases, should precede diagnostic abdominal laparotomy.
Physicians who are uncertain regarding the indications for testinal endoscopy may be guided by the following suggestions:
(1) Esophagoscopy and gastroscopy whenever a gastrointestinal series examination is carried out.
(2) Gastroscopy periodically in patients with atrophic gastritis, gastric achlorhydria or pernicious anemia.
(3) Sigmoidoscopy routinely as part of a complete physical examination and whenever a barium enema examination is carried out.
(4) Peritoneoscopy before a contemplated diagnostic abdominal laparotomy, before thoracotomy is performed for known or suspected pulmonary cancer and in patients with unexplained ascites or jaundice.
Considerable improvement in the early detection of cancer and precancerous conditions can be achieved by increased application of available endoscopic techniques. Still further progress is possible through technical refinements and instrument developments.
A promising recent development is the application of fiberoptic techniques to gastrointestinal endoscopy. The ability to conduct an image through a flexible fiberglass bundle presages eventual endoscopic visualization of the entire gastrointestinal tract. The other is plications of fiberoptic techniques in gastrointestinal endoscopy, however, are limited to gastroscopy, occasional proximal duodenoscopy and the use of fiberoptic bundles as light guides.
