title: Routine staging with endoscopic ultrasound in patients with obstructing esophageal cancer and dysphagia rarely impacts treatment decisions.
abstract: Endoscopic ultrasound (EUS) has been routinely utilized for the locoregional staging of esophageal cancer. One important aspect of clinical staging has been to stratify patients to treatment with neoadjuvant chemoradiation or primary surgical therapy. We hypothesized that EUS may have a limited impact on clinical decision making in patients with dysphagia and obstructing esophageal masses.
  
  
  
  This retrospective cohort study included all patients with esophageal adenocarcinoma undergoing esophageal EUS between July 2008 and September 2013. Dysplastic Barrett's esophagus without invasive adenocarcinoma or incomplete staging was excluded. Patient demographics, endoscopic tumor characteristics, the presence of dysphagia, sonographic staging, and post-EUS therapy were recorded. Pathologic staging for patients who underwent primary surgical therapy was also recorded. Locally advanced disease was defined as at least T3 or N1, as these patients are typically treated with neoadjuvant therapy.
  
  
  
  Two hundred sixteen patients underwent EUS for esophageal adenocarcinoma, with 147 (68.1%) patients having symptoms of dysphagia on initial presentation. Patients with dysphagia were significantly more likely to have locally advanced disease on EUS than patients without dysphagia (p < 0.0001). Additionally, 145 (67.1%) patients had a partially or completely obstructing mass on initial endoscopy, of which 136 (93.8%) were locally advanced (p < 0.0001 vs. non-obstructing lesions).
  
  
  
  An overwhelming majority of patients presenting with dysphagia and/or the presence of at least partially obstructing esophageal mass at the time of esophageal cancer diagnosis had an EUS that demonstrated at least locally advanced disease. The present study supports the hypothesis that EUS may be of limited benefit for management of esophageal cancer in patients with an obstructing mass and dysphagia.
authors.affiliation: General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: Sara A
authors.initials: SA
authors.lastname: Mansfield
authors.affiliation: Section of Advanced Endoscopy, Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, Columbus, OH, 43210, USA.
authors.forename: Samer
authors.initials: S
authors.lastname: El-Dika
authors.affiliation: Section of Advanced Endoscopy, Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, Columbus, OH, 43210, USA.
authors.forename: Somashekar G
authors.initials: SG
authors.lastname: Krishna
authors.affiliation: General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: Kyle A
authors.initials: KA
authors.lastname: Perry
authors.affiliation: Section of Advanced Endoscopy, Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, Columbus, OH, 43210, USA. Jon.walker@osumc.edu.
authors.forename: Jon P
authors.initials: JP
authors.lastname: Walker
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003661:Decision Support Techniques; D019160:Endosonography / Q000379:methods; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: Dysphagia; Endoscopic ultrasound; Esophageal cancer; Staging