Endoscopic Diagnosis

In the past years, the endoscopist was limited to the use of rigid or flexi-rigid open-tipped esophagoscopes; the information that he was able to add in the diagnosis of esophageal malignancy to what had been obtained from a barium meal esophagram and a lavage cytology was often disappointingly small. Angulation and fixation of the esophagus often prevented visualization of the lesion; few endoscopists were able to obtain biopsies showing malignancy from more than 50% of tumors. The introduction of flexible forwardviewing fiberoptic endoscopes, which were 65 cm to 77 cm long, greatly improved this situation.^36-38 These instruments had short controllable tips that permitted easy passage through the esophagus in all patients except those with very tight strictures. The automatic controls for air, water, and suction provided a clear field in the presence of food, mucus, or even active bleeding. Adequate light for both visualization and photography were provided by