title: Endoscopic ultrasound staging of stenotic esophageal cancers may be unnecessary to determine the need for neoadjuvant therapy.
abstract: BACKGROUND
  Endoscopic ultrasound (EUS) is an essential component of preoperative staging for esophageal cancer and is used to determine which patients should proceed to primary surgical resection or receive neoadjuvant therapy prior to surgery. However, when the EUS scope cannot traverse a tumor, the role of pre-dilatation is controversial due to the risk of perforation.
  
  
  METHODS
  A retrospective review was conducted of all patients with esophageal tumor stenosis that could not accommodate the EUS scope who then proceeded with primary esophagectomy. The pathology results were classified based on the revised seventh edition American Joint Committee on Cancer staging system.
  
  
  RESULTS
  A total of 27 patients met inclusion criteria. The majority of tumors were T3 (24/27, 89 %). There were no stage I tumors, 15 % (4/27) were stage II, 81 % (22/27) were stage III, and 4 % (1/27) were stage IV due to a resected solitary lung metastasis.
  
  
  CONCLUSIONS
  Tumors that cannot be assessed with an EUS scope due to tumor stenosis will have locally advanced disease in the majority of cases. In these situations, pre-dilatation of the tumor with EUS staging should be omitted when considering the risk of potential esophageal perforation and the patients should be referred for neoadjuvant therapy.
authors.affiliation: Division of Thoracic and Foregut Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, 1510 San Pablo St Suite 514, Los Angeles, CA, 90033, USA.
authors.forename: Stephanie G
authors.initials: SG
authors.lastname: Worrell
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Oh
authors.forename: Christina L
authors.initials: CL
authors.lastname: Greene
authors.forename: Steven R
authors.initials: SR
authors.lastname: Demeester
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Hagen
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000556:secondary / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D000075202:Contraindications; D004106:Dilatation; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D004940:Esophageal Stenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D012189:Retrospective Studies; D019564:Unnecessary Procedures