Endosonographic examination of gastrointestinal anastomoses with suspected locoregional tumor recurrence.
BACKGROUND
Endoscopic ultrasound is considered one of the best tools for the preoperative staging of esophageal, gastric, and rectal carcinoma. Depending on the individual investigator, the sensitivity of preoperative tumor staging by endosonography of the upper gastrointestinal tract (GEUS) is 80-92% for gastric carcinoma and 86-95% for esophageal carcinoma. However, the sensitivity and specificity of endosonography for the staging of lymph node metastases is less accurate. The accuracy of rectal endosonography (REUS) is approximately 90% for tumor assessment and approximately 80% for the detection of lymph node metastases. In this study, we address the question of whether endosonography enables the surgeon to distinguish scar tissue, which is rather homogeneous and echo-rich, from changes such as an anastomositis or a locoregional tumor recurrence, which are typically non-inhomogeneous and echo-poor.


METHODS
During a 24-months period, we studied patients enrolled in a special tumor follow-up care program by either upper gastrointestinal (GEUS, n = 37 patients) or rectal endosonography (REUS, n = 49 patients) for exclusion of a locoregional tumor recurrence. In each patient, local tumor recurrence was suspected because of either medical history, clinical examination, or other diagnostic procedures.


RESULTS
As in previous studies, our retrospective analysis revealed that endosonography has a high sensitivity in the detection of local tumor recurrences (>90%) for both GEUS and REUS.


CONCLUSIONS
Endosonography is a highly accurate means of detecting local tumor recurrence.
Müller
C
C
Department of General and Visceral Surgery, Friedrich Schiller University of Jena, Germany.
Kähler
G
G
Scheele
J
J
D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D004064:Digestive System / Q000000981:diagnostic imaging; D013505:Digestive System Surgical Procedures; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D004947:Esophagus / Q000601:surgery; D005260:Female; D005743:Gastrectomy; D005770:Gastrointestinal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging*; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery