Prospective study on the value of endosonographic follow-up after surgery for esophageal carcinoma.
BACKGROUND
Half of the patients who undergo surgery for cancer of the esophagus or gastric cardia present with recurrent disease within 2 years after the operation. We investigated the value of endosonography for the early detection of recurrent disease.


METHODS
Forty-three patients entered a follow-up protocol in which endosonography was performed every 6 months within the first 2 years after resection.


RESULTS
During 16 of a total of 66 examinations, suspicious abnormalities were found. In three patients free fluid was seen, but recurrence could not be confirmed during follow-up. In eight patients suspicious lymph nodes were seen; six died within 6 months, one was alive with a proven recurrence at 6 months, and one was alive without recurrence at 22 months. In five patients focal wall-thickening or a mass was seen; three died within 6 months, and two were alive with a proven recurrence at 2 and 5 months. After exclusion of free fluid, the positive predictive value of abnormalities on endoscopic ultrasonography (EUS) was 92%.


CONCLUSIONS
Endosonography, performed at 6-month intervals after resection of cancer of the esophagus or gastric cardia, is accurate in the early detection of locoregional recurrent disease. Two thirds of the patients were still without symptoms when the recurrence was found.
Fockens
P
P
Department of Gastroenterology, Academic Medical Center, University of Amsterdam, The Netherlands.
Manshanden
C G
CG
van Lanschot
J J
JJ
Obertop
H
H
Tytgat
G N
GN
D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000601:surgery; D002299:Cardia; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D013997:Time Factors