title: Do we still need EUS in the workup of patients with early esophageal neoplasia? A retrospective analysis of 131 cases.
abstract: BACKGROUND
  EUS is often used for locoregional staging of early esophageal neoplasia. However, its value compared with that of endoscopic examination and diagnostic endoscopic resection (ER) may be questioned because diagnostic ER allows histological assessment of submucosal invasion and other risk factors for lymph node metastasis, eg, poor differentiation/lymphovascular invasion.
  
  
  OBJECTIVE
  To evaluate how often patients were excluded from endoscopic treatment of esophageal neoplasia based on EUS findings.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Tertiary care institution.
  
  
  METHODS
  Patients with early esophageal neoplasia.
  
  
  METHODS
  EUS, diagnostic ER.
  
  
  METHODS
  Number of patients excluded from endoscopic treatment based on EUS results.
  
  
  RESULTS
  A total of 131 patients were included (98 men, 33 women; age 66 ± 13 years). In 105 of 131 patients (80%), EUS findings were unremarkable. In 25 of 105 patients (24%), diagnostic ER showed submucosal invasion (n = 17), deep resection margins positive for cancer (n = 2, confirmed at surgery), or poor differentiation/lymphovascular invasion (n = 6). In 26 of 131 patients (20%), EUS findings raised the suspicion of submucosal invasion and/or lymph node metastasis. In the 14 of 26 patients (54%) with abnormal EUS findings, endoscopy results were unremarkable. Diagnostic ER showed submucosal invasion in 7 of 14 (50%) patients, whereas no lymph node metastasis risk factors were found in 7 of 14 patients (50%), who subsequently underwent curative endoscopic treatment. In 12 of 26 patients (46%) with abnormal EUS, endoscopy also raised doubts on whether curative endoscopic treatment could be achieved. After diagnostic ER, no risk factors for lymph node metastasis were found in 3 of 12 patients (25%).
  
  
  CONCLUSIONS
  Retrospective study.
  
  
  CONCLUSIONS
  This study shows that EUS has virtually no clinical impact on the workup of early esophageal neoplasia and strengthens the role of diagnostic ER as a final diagnostic step.
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands. r.e.pouw@amc.uva.nl
authors.forename: Roos E
authors.initials: RE
authors.lastname: Pouw
authors.forename: Noor
authors.initials: N
authors.lastname: Heldoorn
authors.forename: Lorenza
authors.initials: L
authors.lastname: Alvarez Herrero
authors.forename: Fiebo J W
authors.initials: FJ
authors.lastname: ten Kate
authors.forename: Mike
authors.initials: M
authors.lastname: Visser
authors.forename: Olivier R
authors.initials: OR
authors.lastname: Busch
authors.forename: Mark I
authors.initials: MI
authors.lastname: van Berge Henegouwen
authors.forename: Kausilia K
authors.initials: KK
authors.lastname: Krishnadath
authors.forename: Bas L
authors.initials: BL
authors.lastname: Weusten
authors.forename: Paul
authors.initials: P
authors.lastname: Fockens
authors.forename: Jacques J
authors.initials: JJ
authors.lastname: Bergman
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D019160:Endosonography / Q000379:methods*; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D009367:Neoplasm Staging / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies