Value of high-frequency miniprobes and conventional radial endoscopic ultrasound in the staging of early Barrett's carcinoma.
OBJECTIVE
High-frequency miniprobes (HFPs) and conventional radial endoscopic ultrasonography (crEUS) are considered valuable tools in the staging of early Barrett's cancer. However, there is some controversy on whether HFPs are superior in the T staging of Barrett's cancer or whether the same level of accuracy can be achieved by the sole use of crEUS.


METHODS
Patients referred for endoscopic treatment for Barrett's cancer were included in this prospective crossover trial and were randomly assigned to either HFPs or crEUS as the initial diagnostic method. Afterwards, all of the patients were re-examined with the alternative procedure. The staging results obtained with each method were documented prospectively.


RESULTS
A total of 43 patients (median age 66 years [interquartile range: 58 - 73]; 34-male) were included. A total of 23 mucosal and 16 submucosal Barrett's cancers were confirmed at histology. Histological confirmation was not possible in four patients. Assessment of the T category was not possible with HFPs in 7 % of patients, compared with 33 % with crEUS ( P < 0.0001) due to positioning problems. T category was correctly assessed with HFP in 64 % of patients and with crEUS in 49 %.


CONCLUSIONS
HFPs are significantly superior to crEUS for local staging of Barrett's cancer. However, the accuracy of assessment of the T category was unsatisfactory with both techniques.
Department of Internal Medicine, HSK Wiesbaden, Wiesbaden, Germany. oliver.pech@t-online.de
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Pech
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Günter
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Dusemund
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Ell
D000368:Aged; D001471:Barrett Esophagus / Q000000981:diagnostic imaging*; D018592:Cross-Over Studies; D003937:Diagnosis, Differential; D019160:Endosonography / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008904:Miniaturization / Q000295:instrumentation*; D011446:Prospective Studies; D015203:Reproducibility of Results