Role of EUS in patients with suspected Barrett’s esophagus with high-grade dysplasia or early esophageal adenocarcinoma: impact on endoscopic therapy

Background and Aims Endoscopic therapy is the standard treatment for high-grade dysplasia and some cases of T1a esophageal adenocarcinoma (EAC), but it is not appropriate for deeply invasive disease. Data on the value of EUS for patient selection for endoscopic or surgical resection are conflicting....

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Bibliographic Details
Published in:Gastrointestinal endoscopy 2017-08, Vol.86 (2), p.292-298
Main Authors: Bartel, Michael J., MD, Wallace, Timothy M, Gomez-Esquivel, Rene D., MD, Raimondo, Massimo, MD, Wolfsen, Herbert C., MD, Woodward, Timothy A., MD, Wallace, Michael B., MD, MPH
Format: Article
Language:English
Subjects:
Adenocarcinoma - diagnostic imaging
Adenocarcinoma - pathology
Adenocarcinoma - surgery
Adult
Aged
Aged, 80 and over
Barrett Esophagus - diagnostic imaging
Barrett Esophagus - pathology
Barrett Esophagus - surgery
Biopsy
Clinical Decision-Making
Endoscopic Mucosal Resection
Endosonography
Esophageal Neoplasms - diagnostic imaging
Esophageal Neoplasms - pathology
Esophageal Neoplasms - surgery
Esophagectomy
Esophagus - diagnostic imaging
Esophagus - pathology
Female
Gastroenterology and Hepatology
Humans
Male
Middle Aged
Neoplasm Staging
Patient Selection
Predictive Value of Tests
Retrospective Studies
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Summary:Background and Aims Endoscopic therapy is the standard treatment for high-grade dysplasia and some cases of T1a esophageal adenocarcinoma (EAC), but it is not appropriate for deeply invasive disease. Data on the value of EUS for patient selection for endoscopic or surgical resection are conflicting. We investigated the outcome of esophageal EUS for the staging and treatment selection of patients with treatment-naive, premalignant Barrett’s esophagus (BE) and suspected superficial EAC. Methods We retrospectively reviewed consecutive patients who underwent EUS for staging of treatment-naive, suspected premalignant BE and superficial EAC from January 2006 to June 2014. All patients referred for endoscopic therapy routinely underwent EUS. Patients with esophageal masses, squamous cell cancers, previous neoadjuvant therapy, or unrelated pathologies were excluded. Each patient’s final diagnosis was verified by EMR, esophagectomy, or forceps biopsy sampling. Test characteristics of EUS were calculated. Results Three hundred thirty-five patients (mean age, 68 years; 86% male) with BE, a Prague C mean of 2.8 cm, and a Prague M mean of 4.5 cm were staged (pT0, 78% [6% nondysplastic, 24% low-grade dysplasia, 42% high-grade dysplasia]; pT1a, 14%; pT1b, 7%; and pT2, 1%). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for patient selection to endoscopic (T1aN0 or less) or surgical therapy with EUS TN staging were 50%, 93%, 40%, 95%, and 90%, respectively. Comparable rates were achieved for patients with nodular BE. Overstaging occurred in 7% of patients, and EUS selected 11% for incorrect treatment modalities compared with pathologic staging. Conclusions This study confirms the limited value of EUS suggested in the latest American College of Gastroenterology guidelines for BE management.
ISSN:0016-5107
1097-6779
DOI:10.1016/j.gie.2016.11.016