title: Utility of EUS following endoscopic polypectomy of high-risk rectosigmoid lesions.
abstract: BACKGROUND
  The utility of endoscopic ultrasound (EUS) compared with standard white light endoscopy (WLE) following recent polypectomy of high-risk colorectal polyps is unknown.
  
  
  OBJECTIVE
  To assess the incremental yield of EUS after endoscopic polypectomy of a high-risk rectal lesion.
  
  
  METHODS
  Retrospective cohort.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Patients referred for EUS following attempted endoscopic resection of a high-risk rectal neoplasm, defined as a tubulovillous adenoma, tubular adenoma with high-grade dysplasia, carcinoid, carcinoma in-situ or adenocarcinoma (CA).
  
  
  METHODS
  Sigmoidoscopy ± mucosal biopsy and EUS ± fine-needle aspiration (FNA) to evaluate for: (1) Residual polyp/tumor in the rectal wall or (2) peritumoral adenopathy.
  
  
  RESULTS
  Sensitivity and specificity for detection of residual neoplasia for WLE ± biopsy (WLE/BX) and EUS ± FNA for cancer (CA group) or benign disease (non-CA group). The incremental yield of EUS defined as: (1) Residual intramural neoplasia not present on WLE ± BX and; (2) abnormal peritumoral adenopathy.
  
  
  RESULTS
  A total of 70 patients (mean age 64 ± 11 years, 61% male) with a final diagnosis of CA (n = 38) and non-CA (n = 32) were identified. There was no difference between the sensitivity and specificity of WLE alone (65% and 84%), WLE with biopsy (71% and 95%), and EUS (59% and 84%), for the detection of residual neoplasia (P > 0.05 for all). EUS identified 3 masses missed by WLE, all in the CA group. A malignant (n = 2) or benign (n = 3) node was identified in 5 (13%) CA patients; EUS-FNA in two showed residual malignancy in one and a reactive lymph node (LN) in one. No LNs were identified in the non-CA patients.
  
  
  CONCLUSIONS
  Retrospective design, incomplete follow-up in some patients.
  
  
  CONCLUSIONS
  Following endoscopic polypectomy of high-risk rectal neoplasia, the incremental yield of EUS compared with WLE/BX for evaluation of residual disease appears limited, especially in patients with benign disease.
authors.affiliation: Medicine Service, Division of Gastroenterology, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA ; Department of Internal Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Leticia P
authors.initials: LP
authors.lastname: Luz
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Cote
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Mohammad A
authors.initials: MA
authors.lastname: Al-Haddad
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Lee
authors.initials: L
authors.lastname: McHenry
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Julia K
authors.initials: JK
authors.lastname: LeBlanc
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Stuart
authors.initials: S
authors.lastname: Sherman
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Moreira
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Ihab I
authors.initials: II
authors.lastname: El Hajj
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: McGreevy
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: John
authors.initials: J
authors.lastname: DeWitt
keywords: Colonic polyps; endosonography; rectal neoplasms