Detection and endoscopic treatment of esophageal neoplasia

Part I contains the general introduction and outline of this thesis. In Part II, endoscopic detection of abnormalities during upper gastrointestinal endoscopy and patients at increased risk of esophageal cancer are assessed. Chapter 2 provides an overview of the current state of artificial intelligence for the detection, characterization, and delineation of cancers in the upper gastrointestinal tract and their premalignant stages. Chapter 3 reports on the risk of esophageal squamous cell carcinoma in patients with distinct grades of squamous dysplasia in a Western country. Part III focuses on second primary tumors (SPTs) in the upper aerodigestive tract. In Chapter 4, the prevalence of lung SPTs in patients with esophageal cancer and vice versa is discussed. Chapter 5 reports on the knowledge and awareness of SPTs among gastroenterologists and head and neck surgeons in the Netherlands. In Chapter 6, endoscopic screening for SPTs in the upper gastrointestinal tract patients with current or previous HNSCC is investigated. This chapter also contains a response letter, discussing the yield of endoscopic screening for esophageal SPTs. Part IV describes endoscopic treatment of early esophageal cancers. Chapter 7 reports on the yield and safety of circumferential endoscopic submucosal dissection (cESD) for esophageal squamous cell carcinoma in Western countries. In this study, curative resection rates in terms of en bloc and radical resections and the risk of esophageal strictures and adverse events related to the cESD are described. In Chapter 8, the risk of local residual cancer after endoscopic resection of Barrett’s neoplasia with confirmed tumor-positive vertical resection margin is explored. A summary and general discussion of this thesis is presented in Chapter 9. The conclusions are presented in Chapter 10.