Endoscopy in the

Management of Gastrointestinal Malignancies

Chapter Overview 43

Introduction 44

Basic Endoscopic Procedures 44

Esophageal Stricture Dilation 45

Percutaneous Endoscopic Gastrostomy 46

Advanced Endoscopic Procedures 47

Endoscopic Retrograde Cholangiopancreatography 47

Procedures in Patients with Acute Cholangitis 48

Endoscopic Ultrasonography 49

Esophageal Cancers 49

Gastric Cancers 51

Pancreatic Cancers 51

Cystic Neoplasms of the Pancreas 53

Celiac Plexus Neurolysis 53

Gastropancreatic Neuroendocrine Tumors 54

Rectal Tumors 54

Indeterminate Mediastinal, Upper Abdominal, and

Pararectal Masses 54

Esophageal and Enteral Stent Placement 55

Key Practice Points 56

Suggested Readings 56

Chapter Overview

Gastrointestinal endoscopy has an important role in the diagnosis, tumor staging, and treatment of patients with known or suspected gastrointestinal cancers and in patients with involvement of the gastrointestinal tract due to extragastrointestinal cancers. Endoscopic ultrasonography (EUS) has emerged as the most accurate method for regional staging (T and N

classification) of esophageal, gastric, and rectal tumors and is a useful adjunct to computed tomography scanning for pretreatment staging in these patients. Endoscopic retrograde cholangiopancreatography and EUS with fine-needle aspiration (EUS-FNA) are invaluable in the diagnostic evaluation of patients with suspected pancreatic cancer. EUS-FNA can detect small pancreatic tumors, which frequently are missed with conventional imaging methods, including computed tomography and magnetic resonance imaging, and can provide a cytologic diagnosis in the vast majority of patients with suspected pancreatic cancer. Early definitive diagnosis of pancreatic tumors by EUS-FNA and their timely treatment can potentially improve outcomes in patients with pancreatic cancer. Endoscopic placement of self-expandable metal stents provides effective palliation in patients with unresectable esophageal, gastric, duodenal, pancreatobiliary, and colorectal cancers and can obviate surgery in these patients.

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