Synopsis
Obtain diagnostic tissue safely, describe upper-GI tumours reproducibly, separate diagnosis from stage, and preserve later endoscopic, surgical and molecular treatment options.
- Describe tumour site relative to incisors, gastro-oesophageal junction, cardia, pylorus and other fixed landmarks because classification changes staging and operation.
- Record length, circumference, morphology, ulceration, bleeding, obstruction and whether the scope passes without force.
- Match sample burden to the lesion: at least eight viable biopsies for advanced oesophageal or gastric cancer, only one or two targeted biopsies for potentially endoscopically resectable neoplasia, and at least ten bite-on-bite samples for suspected gastric linitis.
Key red flags
A negative superficial biopsy does not exclude infiltrative gastric linitis or a submucosal oesophageal process when imaging and endoscopic stiffness remain concerning.
A tight lesion that cannot be traversed should be documented and staged by other modalities rather than dilated solely to complete a diagnostic examination.
Inability to pass safely changes nutrition and staging technique; forceful traversal risks perforation.
Reasoning priorities
Map the lesion and identify the safest viable biopsy targets.
Report fixed landmarks, dimensions, circumference, morphology and traversability with representative images.
Worked reasoning
A 68-year-old with progressive dysphagia has a friable distal oesophageal lesion whose lumen will not admit the standard gastroscope without resistance.
- Record the visible tumour from 34 to 39 cm, its circumferential narrowing and non-traversability, and decide against diagnostic dilation because staging can continue without forcing the scope.
- Obtain eight viable biopsies from different non-necrotic edges in one correctly labelled jar; pathology reports poorly differentiated adenocarcinoma with enough tumour for HER2 and other indicated biomarker testing.
- Staging CT identifies two liver lesions, and an image-guided liver biopsy confirms metastatic adenocarcinoma, making detailed local EUS staging unnecessary.
- Verify that pathology, HER2 testing, CT and nutritional assessment reach the MDT together; the documented outcome is a systemic-treatment consultation plus rapid dysphagia palliation rather than oesophagectomy.