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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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| Published in: | Gastrointestinal endoscopy 2017-08, Vol.86 (2), p.292-298 |
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| container_title | Gastrointestinal endoscopy |
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| creator | 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 |
| description | 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. |
| doi_str_mv | 10.1016/j.gie.2016.11.016 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1844351403</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0016510716307957</els_id><sourcerecordid>1844351403</sourcerecordid><originalsourceid>FETCH-LOGICAL-c408t-3c8a64b8fbfd5b2b4b5d4a65e0ac64ec6bf1be431be7504af9df106aefe26cff3</originalsourceid><addsrcrecordid>eNp9ks2KFDEUhYMoTjv6AG4kSzdVJlWpPwVhHMYfGBAcZx1uJTddaasrZZJSaudbiK_nk5ime1y4cJMTwncO5J5LyFPOcs54_WKXby3mRbrmnOdJ7pENZ12T1U3T3Scblp6yirPmjDwKYccYa4uSPyRnRdO2XSXEhvz85EakztCr2xtqJzpDtDjFQL_bONCwhBlVRE3fgPcY4-8fvwLF4OYBtssJGux2yLYeNFK9hnmEYIE6TxH8uN7BCCNNxOQUeGUnt4eX1O5nUJG6ieKkXVButorGAT3M62PywMAY8MlJz8nt26vPl--z64_vPlxeXGdKsDZmpWqhFn1reqOrvuhFX2kBdYUMVC1Q1b3hPYoyHU3FBJhOG85qQINFrYwpz8nzY-7s3dcFQ5R7GxSOI0zoliB5K0RZccHKhPIjqrwLwaORs7d78KvkTB76kDuZ-pCHPiTnMknyPDvFL_0e9V_HXQEJeHUEMH3ym0Uvg0oFKNTWp8lL7ex_41__41ajnayC8QuuGHZu8VOanuQyFJLJm8NCHPYhWVnTVU35Bw04tY4</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1844351403</pqid></control><display><type>article</type><title>Role of EUS in patients with suspected Barrett’s esophagus with high-grade dysplasia or early esophageal adenocarcinoma: impact on endoscopic therapy</title><source>ScienceDirect Freedom Collection</source><creator>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</creator><creatorcontrib>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</creatorcontrib><description>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.</description><identifier>ISSN: 0016-5107</identifier><identifier>EISSN: 1097-6779</identifier><identifier>DOI: 10.1016/j.gie.2016.11.016</identifier><identifier>PMID: 27889544</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>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</subject><ispartof>Gastrointestinal endoscopy, 2017-08, Vol.86 (2), p.292-298</ispartof><rights>2017</rights><rights>Copyright © 2017. Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c408t-3c8a64b8fbfd5b2b4b5d4a65e0ac64ec6bf1be431be7504af9df106aefe26cff3</citedby><cites>FETCH-LOGICAL-c408t-3c8a64b8fbfd5b2b4b5d4a65e0ac64ec6bf1be431be7504af9df106aefe26cff3</cites><orcidid>0000-0002-6446-5785 ; 0000-0003-4666-1544</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27889544$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bartel, Michael J., MD</creatorcontrib><creatorcontrib>Wallace, Timothy M</creatorcontrib><creatorcontrib>Gomez-Esquivel, Rene D., MD</creatorcontrib><creatorcontrib>Raimondo, Massimo, MD</creatorcontrib><creatorcontrib>Wolfsen, Herbert C., MD</creatorcontrib><creatorcontrib>Woodward, Timothy A., MD</creatorcontrib><creatorcontrib>Wallace, Michael B., MD, MPH</creatorcontrib><title>Role of EUS in patients with suspected Barrett’s esophagus with high-grade dysplasia or early esophageal adenocarcinoma: impact on endoscopic therapy</title><title>Gastrointestinal endoscopy</title><addtitle>Gastrointest Endosc</addtitle><description>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.</description><subject>Adenocarcinoma - diagnostic imaging</subject><subject>Adenocarcinoma - pathology</subject><subject>Adenocarcinoma - surgery</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Barrett Esophagus - diagnostic imaging</subject><subject>Barrett Esophagus - pathology</subject><subject>Barrett Esophagus - surgery</subject><subject>Biopsy</subject><subject>Clinical Decision-Making</subject><subject>Endoscopic Mucosal Resection</subject><subject>Endosonography</subject><subject>Esophageal Neoplasms - diagnostic imaging</subject><subject>Esophageal Neoplasms - pathology</subject><subject>Esophageal Neoplasms - surgery</subject><subject>Esophagectomy</subject><subject>Esophagus - diagnostic imaging</subject><subject>Esophagus - pathology</subject><subject>Female</subject><subject>Gastroenterology and Hepatology</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoplasm Staging</subject><subject>Patient Selection</subject><subject>Predictive Value of Tests</subject><subject>Retrospective Studies</subject><issn>0016-5107</issn><issn>1097-6779</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><recordid>eNp9ks2KFDEUhYMoTjv6AG4kSzdVJlWpPwVhHMYfGBAcZx1uJTddaasrZZJSaudbiK_nk5ime1y4cJMTwncO5J5LyFPOcs54_WKXby3mRbrmnOdJ7pENZ12T1U3T3Scblp6yirPmjDwKYccYa4uSPyRnRdO2XSXEhvz85EakztCr2xtqJzpDtDjFQL_bONCwhBlVRE3fgPcY4-8fvwLF4OYBtssJGux2yLYeNFK9hnmEYIE6TxH8uN7BCCNNxOQUeGUnt4eX1O5nUJG6ieKkXVButorGAT3M62PywMAY8MlJz8nt26vPl--z64_vPlxeXGdKsDZmpWqhFn1reqOrvuhFX2kBdYUMVC1Q1b3hPYoyHU3FBJhOG85qQINFrYwpz8nzY-7s3dcFQ5R7GxSOI0zoliB5K0RZccHKhPIjqrwLwaORs7d78KvkTB76kDuZ-pCHPiTnMknyPDvFL_0e9V_HXQEJeHUEMH3ym0Uvg0oFKNTWp8lL7ex_41__41ajnayC8QuuGHZu8VOanuQyFJLJm8NCHPYhWVnTVU35Bw04tY4</recordid><startdate>20170801</startdate><enddate>20170801</enddate><creator>Bartel, Michael J., MD</creator><creator>Wallace, Timothy M</creator><creator>Gomez-Esquivel, Rene D., MD</creator><creator>Raimondo, Massimo, MD</creator><creator>Wolfsen, Herbert C., MD</creator><creator>Woodward, Timothy A., MD</creator><creator>Wallace, Michael B., MD, MPH</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6446-5785</orcidid><orcidid>https://orcid.org/0000-0003-4666-1544</orcidid></search><sort><creationdate>20170801</creationdate><title>Role of EUS in patients with suspected Barrett’s esophagus with high-grade dysplasia or early esophageal adenocarcinoma: impact on endoscopic therapy</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c408t-3c8a64b8fbfd5b2b4b5d4a65e0ac64ec6bf1be431be7504af9df106aefe26cff3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adenocarcinoma - diagnostic imaging</topic><topic>Adenocarcinoma - pathology</topic><topic>Adenocarcinoma - surgery</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Barrett Esophagus - diagnostic imaging</topic><topic>Barrett Esophagus - pathology</topic><topic>Barrett Esophagus - surgery</topic><topic>Biopsy</topic><topic>Clinical Decision-Making</topic><topic>Endoscopic Mucosal Resection</topic><topic>Endosonography</topic><topic>Esophageal Neoplasms - diagnostic imaging</topic><topic>Esophageal Neoplasms - pathology</topic><topic>Esophageal Neoplasms - surgery</topic><topic>Esophagectomy</topic><topic>Esophagus - diagnostic imaging</topic><topic>Esophagus - pathology</topic><topic>Female</topic><topic>Gastroenterology and Hepatology</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neoplasm Staging</topic><topic>Patient Selection</topic><topic>Predictive Value of Tests</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bartel, Michael J., MD</creatorcontrib><creatorcontrib>Wallace, Timothy M</creatorcontrib><creatorcontrib>Gomez-Esquivel, Rene D., MD</creatorcontrib><creatorcontrib>Raimondo, Massimo, MD</creatorcontrib><creatorcontrib>Wolfsen, Herbert C., MD</creatorcontrib><creatorcontrib>Woodward, Timothy A., MD</creatorcontrib><creatorcontrib>Wallace, Michael B., MD, MPH</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Gastrointestinal endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bartel, Michael J., MD</au><au>Wallace, Timothy M</au><au>Gomez-Esquivel, Rene D., MD</au><au>Raimondo, Massimo, MD</au><au>Wolfsen, Herbert C., MD</au><au>Woodward, Timothy A., MD</au><au>Wallace, Michael B., MD, MPH</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Role of EUS in patients with suspected Barrett’s esophagus with high-grade dysplasia or early esophageal adenocarcinoma: impact on endoscopic therapy</atitle><jtitle>Gastrointestinal endoscopy</jtitle><addtitle>Gastrointest Endosc</addtitle><date>2017-08-01</date><risdate>2017</risdate><volume>86</volume><issue>2</issue><spage>292</spage><epage>298</epage><pages>292-298</pages><issn>0016-5107</issn><eissn>1097-6779</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27889544</pmid><doi>10.1016/j.gie.2016.11.016</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-6446-5785</orcidid><orcidid>https://orcid.org/0000-0003-4666-1544</orcidid></addata></record> |
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| 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 |
| title | Role of EUS in patients with suspected Barrett’s esophagus with high-grade dysplasia or early esophageal adenocarcinoma: impact on endoscopic therapy |
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