Esophageal cancer. Facts, figures, and screening.

Over the last 25 years, the incidence of adenocarcinoma of the esophagus has increased 350%, faster than any other malignancy in the western world. This increase is largely due to gastroesophageal reflux disease and Barrett's esophagus. While the current incidence of esophageal cancer is relatively low in comparison to other cancers in the United States, this may rapidly change. A cost-effective screening technique is needed for populations at risk for adenocarcinoma of the esophagus. Using unsedated esophagoscopy, gastroenterology nurses may be in the best position to coordinate and perform esophageal cancer screening for the U.S. population. This article provides an overview of esophageal cancer, including types, etiology, symptoms, and diagnosis. In addition to an overview of esophageal cancer, this article provides a look at non-physician, unsedated esophagoscopy as a future direction for esophageal cancer screening.

Remote clinical assessment of gastrointestinal endoscopy (tele-endoscopy): an initial experience.

BACKGROUND: Gastrointestinal (GI) endoscopy is an effective tool to screen for cancers of the digestive tract. However, access to endoscopy is limited in many parts of South Carolina. This trial is a part of a prospective multi-part study for remote cancer screening in coastal South Carolina. This pilot study was to evaluate the quality of tele-endoscopy for cancer screening. METHODS: 10 patients scheduled for endoscopic procedures were observed simultaneously by the endoscopist and a remote observer connected over a 512 kbps ISDN line. Findings by both were compared for concordance on malignant or premalignant lesions. RESULTS: The image quality was adequate to support remote diagnosis of GI cancer and abnormal lesions by an experienced observer. However, assessment of the esophagogastric junction for Barrett's esophagus was equivocal. CONCLUSIONS: Overall, our tele-endoscopy setup shows great promise for remote supervision or observation of endoscopic procedures done by nurse endoscopists. Tele-endoscopy is both adequate and feasible for diagnosis of most gastrointestinal lesions. Subtle lesions still may be missed in our current setup. However, improvements are being made in our setup to address the problem with resolution prior to further evaluation.