Endoscopic Diagnosis

Advancements in endoscopic techniques have revolutionized the detection, characterization, and staging of esophageal squamous cell carcinoma (ESCC), enhancing early diagnosis and clinical outcomes. Detection methods, including narrow-band imaging (NBI) and iodine chromoendoscopy, have significantly improved the visualization of subtle lesions. NBI highlights microvascular structures, offering diagnostic sensitivity comparable to iodine staining but without associated patient discomfort. Observing the esophagus in a deflated state further optimizes lesion contrast and facilitates the identification of superficial ESCCs. Characterization of superficial ESCC has been refined through magnifying endoscopy and advanced technologies like endocytoscopy, which enable real-time optical biopsies. The Japan Esophageal Society classification and the “pink-color sign” after iodine staining enhance diagnostic specificity by distinguishing malignant from benign lesions based on vascular patterns and tissue color changes. Staging of ESCC involves non-magnifying endoscopy to assess invasion depth based on surface irregularities and stiffness, with magnifying endoscopy and NBI refining diagnosis via microvascular patterns. Endoscopic ultrasound (EUS) provides invasion depth assessment by visualizing esophageal wall layers but requires cautious use due to potential overdiagnosis and limited accuracy improvement. Emerging computer-aided diagnosis systems powered by artificial intelligence (AI) address variability in endoscopic interpretation. These systems enhance lesion detection, characterization, and staging, offering diagnostic accuracy comparable to expert endoscopists. Integrating AI into routine practice may reduce missed diagnoses and facilitates early intervention.