Gastrointestinal Endoscopy: Position statement by ESGE

The European Society of Gastrointestinal Endoscopy (ESGE) has published a position statement on the role of gastrointestinal endoscopy in screening for digestive tract cancers. Through this document, ESGE aims to summarize its position regarding the current role of endoscopy in screening for the diverse gastrointestinal neoplasms and to support the role of digestive endoscopy in the reduction of cancer incidence and mortality.The position statement has been published in Journal Endoscopy. 

Mostly because of the ageing population and environmental risk factors, gastrointestinal (GI) cancers represent a significant burden for European citizens, comprising one-quarter of all the malignancies diagnosed in Europe. In Europe at present, but also in 2040, 1 in 3 cancer-related deaths are expected to be caused by digestive cancers. Endoscopic technologies enable diagnosis, with relatively low invasiveness, of precancerous conditions and early cancers, thereby improving patient survival. Overall, endoscopy capacity must be adjusted to facilitate both effective screening programs and rigorous control of the quality assurance and surveillance systems required.

Key recommendations are-

1 For average-risk populations, ESGE recommends the implementation of organized population-based screening programs for colorectal cancer, based on fecal immunochemical testing (FIT), targeting individuals, irrespective of gender, aged between 50 and 75 years. Depending on local factors, namely the adherence of the target population and availability of endoscopy services, primary screening by colonoscopy or sigmoidoscopy may also be recommendable.

2 In high-risk populations, endoscopic screening for gastric cancer should be considered for individuals aged more than 40 years. Its use in countries/regions with intermediate-risk may be considered on the basis of local settings and availability of endoscopic resources.

3 For oesophagal and pancreatic cancer, endoscopic screening may be considered only in high-risk individuals:

– For squamous cell carcinoma, in those with a personal history of head/neck cancer, achalasia, or previous caustic injury;

– For Barrett's oesophagus (BE)-associated adenocarcinoma, in those with long-standing gastroesophageal reflux disease symptoms (i. e., > 5 years) and multiple risk factors (age ≥ 50 years, white race, male sex, obesity, first-degree relative with BE or oesophagal adenocarcinoma [EAC]).

– For pancreatic cancer screening, endoscopic ultrasound may be used in selected high-risk patients such as those with strong family history and/or genetic susceptibility.

For further reference-

Săftoiu A, Hassan C, Areia M, Bhutani MS, Bisschops R, Bories E, et al. Role of gastrointestinal endoscopy in the screening of digestive tract cancers in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy. 2020 Feb 12. doi: 10.1055/a-1104-5245. PMID: 32052404. [Epub ahead of print]