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Dig Endosc. 2016 Sep;28(6):650-6. doi: 10.1111/den.12658. Epub 2016 Apr 21.

Endoscopic ultrasonography is not required for staging malignant esophageal strictures that preclude the passage of a diagnostic gastroscope.

Author information

1
Division of Gastroenterology & Hepatology, Indiana University, Indianapolis, USA.
2
Division of Gastroenterology & Hepatology, University of Alabama at Birmingham, Birmingham, USA.
3
Center for Interventional Endoscopy, Florida Hospital, Orlando, USA.

Abstract

BACKGROUND AND AIM:

Endoscopic ultrasound (EUS) is considered the most sensitive modality for local staging of esophageal cancer (ECA) and current guidelines recommend EUS in all patients with non-metastatic disease. Our aim was to identify a subset of patients with stenotic, non-metastatic ECA who will not benefit from staging EUS.

METHODS:

This multicenter study evaluated consecutive patients with newly diagnosed non-metastatic ECA referred for local staging by EUS. All patients had endoscopic evaluation of malignant strictures with 9.8/9.9-mm diagnostic gastroscope prior to EUS. Main outcome measure was to evaluate the relationship between degree of malignant stenosis and tumor staging by EUS.

RESULTS:

Of 100 patients (median age, 65 years; male 81%), gastroscope could not be advanced past the stricture in 46, all of whom (100%) had locally advanced disease at EUS: T3N0/N+ in 39 and T4N0/N+ in seven. Echoendoscope could not traverse the stricture in any of these patients. Gastroscope could be advanced through the stricture in 54 patients in whom EUS staging was T1N0 in five, T2N0/N+ in eight and T3N0/N+ in 41; echoendoscope could not pass through the stricture in 24 of these 54 (44.4%) patients, all of whom had T3N0/N+ disease. On logistic regression analysis, inability to pass a gastroscope through the stricture was significantly associated with advanced (T3/4) tumor stage (OR = 28.7, 95% CI = 1.64-501.2; P = 0.021).

CONCLUSION:

Routine EUS examination may not be required in all patients with ECA as the inability to advance a diagnostic gastroscope past a malignant stricture correlates 100% with locally advanced disease on EUS.

KEYWORDS:

endoscopic ultrasound; esophageal cancer; lymph node staging; stricture; tumor staging

PMID:
27001640
DOI:
10.1111/den.12658
[Indexed for MEDLINE]

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