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Do we still need EUS in the workup of patients with early esophageal neoplasia? A retrospective analysis of 131 cases
Background EUS is often used for locoregional staging of early esophageal neoplasia. However, its value compared with that of endoscopic examination and diagnostic endoscopic resection (ER) may be questioned because diagnostic ER allows histological assessment of submucosal invasion and other risk f...
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| Published in: | Gastrointestinal endoscopy 2011-04, Vol.73 (4), p.662-668 |
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| creator | Pouw, Roos E., MD Heldoorn, Noor, BSc Herrero, Lorenza Alvarez, MD ten Kate, Fiebo J.W., MD, PhD Visser, Mike, MD Busch, Olivier R., MD, PhD van Berge Henegouwen, Mark I., MD, PhD Krishnadath, Kausilia K., MD, PhD Weusten, Bas L., MD, PhD Fockens, Paul, MD, PhD Bergman, Jacques J., MD, PhD |
| description | Background EUS is often used for locoregional staging of early esophageal neoplasia. However, its value compared with that of endoscopic examination and diagnostic endoscopic resection (ER) may be questioned because diagnostic ER allows histological assessment of submucosal invasion and other risk factors for lymph node metastasis, eg, poor differentiation/lymphovascular invasion. Objective To evaluate how often patients were excluded from endoscopic treatment of esophageal neoplasia based on EUS findings. Design Retrospective cohort study. Setting Tertiary care institution. Patients Patients with early esophageal neoplasia. Interventions EUS, diagnostic ER. Main Outcome Measurements Number of patients excluded from endoscopic treatment based on EUS results. Results A total of 131 patients were included (98 men, 33 women; age 66 ± 13 years). In 105 of 131 patients (80%), EUS findings were unremarkable. In 25 of 105 patients (24%), diagnostic ER showed submucosal invasion (n = 17), deep resection margins positive for cancer (n = 2, confirmed at surgery), or poor differentiation/lymphovascular invasion (n = 6). In 26 of 131 patients (20%), EUS findings raised the suspicion of submucosal invasion and/or lymph node metastasis. In the 14 of 26 patients (54%) with abnormal EUS findings, endoscopy results were unremarkable. Diagnostic ER showed submucosal invasion in 7 of 14 (50%) patients, whereas no lymph node metastasis risk factors were found in 7 of 14 patients (50%), who subsequently underwent curative endoscopic treatment. In 12 of 26 patients (46%) with abnormal EUS, endoscopy also raised doubts on whether curative endoscopic treatment could be achieved. After diagnostic ER, no risk factors for lymph node metastasis were found in 3 of 12 patients (25%). Limitation Retrospective study. Conclusions This study shows that EUS has virtually no clinical impact on the workup of early esophageal neoplasia and strengthens the role of diagnostic ER as a final diagnostic step. |
| doi_str_mv | 10.1016/j.gie.2010.10.046 |
| format | article |
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A retrospective analysis of 131 cases</title><source>ScienceDirect Freedom Collection 2022-2024</source><creator>Pouw, Roos E., MD ; Heldoorn, Noor, BSc ; Herrero, Lorenza Alvarez, MD ; ten Kate, Fiebo J.W., MD, PhD ; Visser, Mike, MD ; Busch, Olivier R., MD, PhD ; van Berge Henegouwen, Mark I., MD, PhD ; Krishnadath, Kausilia K., MD, PhD ; Weusten, Bas L., MD, PhD ; Fockens, Paul, MD, PhD ; Bergman, Jacques J., MD, PhD</creator><creatorcontrib>Pouw, Roos E., MD ; Heldoorn, Noor, BSc ; Herrero, Lorenza Alvarez, MD ; ten Kate, Fiebo J.W., MD, PhD ; Visser, Mike, MD ; Busch, Olivier R., MD, PhD ; van Berge Henegouwen, Mark I., MD, PhD ; Krishnadath, Kausilia K., MD, PhD ; Weusten, Bas L., MD, PhD ; Fockens, Paul, MD, PhD ; Bergman, Jacques J., MD, PhD</creatorcontrib><description>Background EUS is often used for locoregional staging of early esophageal neoplasia. However, its value compared with that of endoscopic examination and diagnostic endoscopic resection (ER) may be questioned because diagnostic ER allows histological assessment of submucosal invasion and other risk factors for lymph node metastasis, eg, poor differentiation/lymphovascular invasion. Objective To evaluate how often patients were excluded from endoscopic treatment of esophageal neoplasia based on EUS findings. Design Retrospective cohort study. Setting Tertiary care institution. Patients Patients with early esophageal neoplasia. Interventions EUS, diagnostic ER. Main Outcome Measurements Number of patients excluded from endoscopic treatment based on EUS results. Results A total of 131 patients were included (98 men, 33 women; age 66 ± 13 years). In 105 of 131 patients (80%), EUS findings were unremarkable. In 25 of 105 patients (24%), diagnostic ER showed submucosal invasion (n = 17), deep resection margins positive for cancer (n = 2, confirmed at surgery), or poor differentiation/lymphovascular invasion (n = 6). In 26 of 131 patients (20%), EUS findings raised the suspicion of submucosal invasion and/or lymph node metastasis. In the 14 of 26 patients (54%) with abnormal EUS findings, endoscopy results were unremarkable. Diagnostic ER showed submucosal invasion in 7 of 14 (50%) patients, whereas no lymph node metastasis risk factors were found in 7 of 14 patients (50%), who subsequently underwent curative endoscopic treatment. In 12 of 26 patients (46%) with abnormal EUS, endoscopy also raised doubts on whether curative endoscopic treatment could be achieved. After diagnostic ER, no risk factors for lymph node metastasis were found in 3 of 12 patients (25%). Limitation Retrospective study. Conclusions This study shows that EUS has virtually no clinical impact on the workup of early esophageal neoplasia and strengthens the role of diagnostic ER as a final diagnostic step.</description><identifier>ISSN: 0016-5107</identifier><identifier>EISSN: 1097-6779</identifier><identifier>DOI: 10.1016/j.gie.2010.10.046</identifier><identifier>PMID: 21272876</identifier><identifier>CODEN: GAENBQ</identifier><language>eng</language><publisher>Maryland heights, MO: Mosby, Inc</publisher><subject>Aged ; Biological and medical sciences ; Diagnosis, Differential ; Digestive system. Abdomen ; Early Diagnosis ; Endoscopy ; Endosonography - methods ; Esophageal Neoplasms - diagnostic imaging ; Female ; Gastroenterology and Hepatology ; Gastroenterology. Liver. Pancreas. Abdomen ; Humans ; Investigative techniques, diagnostic techniques (general aspects) ; Male ; Medical sciences ; Neoplasm Staging - methods ; Reproducibility of Results ; Retrospective Studies</subject><ispartof>Gastrointestinal endoscopy, 2011-04, Vol.73 (4), p.662-668</ispartof><rights>American Society for Gastrointestinal Endoscopy</rights><rights>2011 American Society for Gastrointestinal Endoscopy</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2011 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c437t-a33ad94bf570af6522b09503dfab515bef38c86cc2c5b00b1059ae6bdd7c78b93</citedby><cites>FETCH-LOGICAL-c437t-a33ad94bf570af6522b09503dfab515bef38c86cc2c5b00b1059ae6bdd7c78b93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24043069$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21272876$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pouw, Roos E., MD</creatorcontrib><creatorcontrib>Heldoorn, Noor, BSc</creatorcontrib><creatorcontrib>Herrero, Lorenza Alvarez, MD</creatorcontrib><creatorcontrib>ten Kate, Fiebo J.W., MD, PhD</creatorcontrib><creatorcontrib>Visser, Mike, MD</creatorcontrib><creatorcontrib>Busch, Olivier R., MD, PhD</creatorcontrib><creatorcontrib>van Berge Henegouwen, Mark I., MD, PhD</creatorcontrib><creatorcontrib>Krishnadath, Kausilia K., MD, PhD</creatorcontrib><creatorcontrib>Weusten, Bas L., MD, PhD</creatorcontrib><creatorcontrib>Fockens, Paul, MD, PhD</creatorcontrib><creatorcontrib>Bergman, Jacques J., MD, PhD</creatorcontrib><title>Do we still need EUS in the workup of patients with early esophageal neoplasia? A retrospective analysis of 131 cases</title><title>Gastrointestinal endoscopy</title><addtitle>Gastrointest Endosc</addtitle><description>Background EUS is often used for locoregional staging of early esophageal neoplasia. However, its value compared with that of endoscopic examination and diagnostic endoscopic resection (ER) may be questioned because diagnostic ER allows histological assessment of submucosal invasion and other risk factors for lymph node metastasis, eg, poor differentiation/lymphovascular invasion. Objective To evaluate how often patients were excluded from endoscopic treatment of esophageal neoplasia based on EUS findings. Design Retrospective cohort study. Setting Tertiary care institution. Patients Patients with early esophageal neoplasia. Interventions EUS, diagnostic ER. Main Outcome Measurements Number of patients excluded from endoscopic treatment based on EUS results. Results A total of 131 patients were included (98 men, 33 women; age 66 ± 13 years). In 105 of 131 patients (80%), EUS findings were unremarkable. In 25 of 105 patients (24%), diagnostic ER showed submucosal invasion (n = 17), deep resection margins positive for cancer (n = 2, confirmed at surgery), or poor differentiation/lymphovascular invasion (n = 6). In 26 of 131 patients (20%), EUS findings raised the suspicion of submucosal invasion and/or lymph node metastasis. In the 14 of 26 patients (54%) with abnormal EUS findings, endoscopy results were unremarkable. Diagnostic ER showed submucosal invasion in 7 of 14 (50%) patients, whereas no lymph node metastasis risk factors were found in 7 of 14 patients (50%), who subsequently underwent curative endoscopic treatment. In 12 of 26 patients (46%) with abnormal EUS, endoscopy also raised doubts on whether curative endoscopic treatment could be achieved. After diagnostic ER, no risk factors for lymph node metastasis were found in 3 of 12 patients (25%). Limitation Retrospective study. Conclusions This study shows that EUS has virtually no clinical impact on the workup of early esophageal neoplasia and strengthens the role of diagnostic ER as a final diagnostic step.</description><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Diagnosis, Differential</subject><subject>Digestive system. Abdomen</subject><subject>Early Diagnosis</subject><subject>Endoscopy</subject><subject>Endosonography - methods</subject><subject>Esophageal Neoplasms - diagnostic imaging</subject><subject>Female</subject><subject>Gastroenterology and Hepatology</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Humans</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Neoplasm Staging - methods</subject><subject>Reproducibility of Results</subject><subject>Retrospective Studies</subject><issn>0016-5107</issn><issn>1097-6779</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><recordid>eNp9ks1u1DAURi0EokPhAdggbxCrDNd24iRCAlWl_EiVWJSuLce56XjqSYJv0tG8PQ4zgMSClWXrfNefjs3YSwFrAUK_3a7vPK4l_NqvIdeP2EpAXWa6LOvHbAUJygoB5Rl7RrQFgEoq8ZSdSSFLWZV6xeaPA98jp8mHwHvEll_d3nDf82mDfD_E-3nkQ8dHO3nsJ-J7P2042hgOHGkYN_YO7RIcxmDJ2w_8gkec4kAjusk_ILe9DQfytEwRSnBnCek5e9LZQPjitJ6z209X3y-_ZNffPn-9vLjOXK7KKbNK2bbOm64owXa6kLKBugDVdrYpRNFgpypXaeekKxqARkBRW9RN25aurJpanbM3x7ljHH7MSJPZeXIYgk2NZzKVBlHluZSJFEfSpe4UsTNj9DsbD0aAWWSbrUmyzSJ7OUqyU-bVafrc7LD9k_htNwGvT4AlZ0MXbe88_eVyyBXopea7I4fJxYPHaMgl3Q5bH5NG0w7-vzXe_5N2wfc-XXiPB6TtMMf0BmSEIWnA3Cy_YvkUAkDKWoP6CRBUsWQ</recordid><startdate>20110401</startdate><enddate>20110401</enddate><creator>Pouw, Roos E., MD</creator><creator>Heldoorn, Noor, BSc</creator><creator>Herrero, Lorenza Alvarez, MD</creator><creator>ten Kate, Fiebo J.W., MD, PhD</creator><creator>Visser, Mike, MD</creator><creator>Busch, Olivier R., MD, PhD</creator><creator>van Berge Henegouwen, Mark I., MD, PhD</creator><creator>Krishnadath, Kausilia K., MD, PhD</creator><creator>Weusten, Bas L., MD, PhD</creator><creator>Fockens, Paul, MD, PhD</creator><creator>Bergman, Jacques J., MD, PhD</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>IQODW</scope><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></search><sort><creationdate>20110401</creationdate><title>Do we still need EUS in the workup of patients with early esophageal neoplasia? A retrospective analysis of 131 cases</title><author>Pouw, Roos E., MD ; Heldoorn, Noor, BSc ; Herrero, Lorenza Alvarez, MD ; ten Kate, Fiebo J.W., MD, PhD ; Visser, Mike, MD ; Busch, Olivier R., MD, PhD ; van Berge Henegouwen, Mark I., MD, PhD ; Krishnadath, Kausilia K., MD, PhD ; Weusten, Bas L., MD, PhD ; Fockens, Paul, MD, PhD ; Bergman, Jacques J., MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c437t-a33ad94bf570af6522b09503dfab515bef38c86cc2c5b00b1059ae6bdd7c78b93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Diagnosis, Differential</topic><topic>Digestive system. Abdomen</topic><topic>Early Diagnosis</topic><topic>Endoscopy</topic><topic>Endosonography - methods</topic><topic>Esophageal Neoplasms - diagnostic imaging</topic><topic>Female</topic><topic>Gastroenterology and Hepatology</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>Humans</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Neoplasm Staging - methods</topic><topic>Reproducibility of Results</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pouw, Roos E., MD</creatorcontrib><creatorcontrib>Heldoorn, Noor, BSc</creatorcontrib><creatorcontrib>Herrero, Lorenza Alvarez, MD</creatorcontrib><creatorcontrib>ten Kate, Fiebo J.W., MD, PhD</creatorcontrib><creatorcontrib>Visser, Mike, MD</creatorcontrib><creatorcontrib>Busch, Olivier R., MD, PhD</creatorcontrib><creatorcontrib>van Berge Henegouwen, Mark I., MD, PhD</creatorcontrib><creatorcontrib>Krishnadath, Kausilia K., MD, PhD</creatorcontrib><creatorcontrib>Weusten, Bas L., MD, PhD</creatorcontrib><creatorcontrib>Fockens, Paul, MD, PhD</creatorcontrib><creatorcontrib>Bergman, Jacques J., MD, PhD</creatorcontrib><collection>Pascal-Francis</collection><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>Pouw, Roos E., MD</au><au>Heldoorn, Noor, BSc</au><au>Herrero, Lorenza Alvarez, MD</au><au>ten Kate, Fiebo J.W., MD, PhD</au><au>Visser, Mike, MD</au><au>Busch, Olivier R., MD, PhD</au><au>van Berge Henegouwen, Mark I., MD, PhD</au><au>Krishnadath, Kausilia K., MD, PhD</au><au>Weusten, Bas L., MD, PhD</au><au>Fockens, Paul, MD, PhD</au><au>Bergman, Jacques J., MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Do we still need EUS in the workup of patients with early esophageal neoplasia? A retrospective analysis of 131 cases</atitle><jtitle>Gastrointestinal endoscopy</jtitle><addtitle>Gastrointest Endosc</addtitle><date>2011-04-01</date><risdate>2011</risdate><volume>73</volume><issue>4</issue><spage>662</spage><epage>668</epage><pages>662-668</pages><issn>0016-5107</issn><eissn>1097-6779</eissn><coden>GAENBQ</coden><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Background EUS is often used for locoregional staging of early esophageal neoplasia. However, its value compared with that of endoscopic examination and diagnostic endoscopic resection (ER) may be questioned because diagnostic ER allows histological assessment of submucosal invasion and other risk factors for lymph node metastasis, eg, poor differentiation/lymphovascular invasion. Objective To evaluate how often patients were excluded from endoscopic treatment of esophageal neoplasia based on EUS findings. Design Retrospective cohort study. Setting Tertiary care institution. Patients Patients with early esophageal neoplasia. Interventions EUS, diagnostic ER. Main Outcome Measurements Number of patients excluded from endoscopic treatment based on EUS results. Results A total of 131 patients were included (98 men, 33 women; age 66 ± 13 years). In 105 of 131 patients (80%), EUS findings were unremarkable. In 25 of 105 patients (24%), diagnostic ER showed submucosal invasion (n = 17), deep resection margins positive for cancer (n = 2, confirmed at surgery), or poor differentiation/lymphovascular invasion (n = 6). In 26 of 131 patients (20%), EUS findings raised the suspicion of submucosal invasion and/or lymph node metastasis. In the 14 of 26 patients (54%) with abnormal EUS findings, endoscopy results were unremarkable. Diagnostic ER showed submucosal invasion in 7 of 14 (50%) patients, whereas no lymph node metastasis risk factors were found in 7 of 14 patients (50%), who subsequently underwent curative endoscopic treatment. In 12 of 26 patients (46%) with abnormal EUS, endoscopy also raised doubts on whether curative endoscopic treatment could be achieved. After diagnostic ER, no risk factors for lymph node metastasis were found in 3 of 12 patients (25%). Limitation Retrospective study. Conclusions This study shows that EUS has virtually no clinical impact on the workup of early esophageal neoplasia and strengthens the role of diagnostic ER as a final diagnostic step.</abstract><cop>Maryland heights, MO</cop><pub>Mosby, Inc</pub><pmid>21272876</pmid><doi>10.1016/j.gie.2010.10.046</doi><tpages>7</tpages></addata></record> |
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| subjects | Aged Biological and medical sciences Diagnosis, Differential Digestive system. Abdomen Early Diagnosis Endoscopy Endosonography - methods Esophageal Neoplasms - diagnostic imaging Female Gastroenterology and Hepatology Gastroenterology. Liver. Pancreas. Abdomen Humans Investigative techniques, diagnostic techniques (general aspects) Male Medical sciences Neoplasm Staging - methods Reproducibility of Results Retrospective Studies |
| title | Do we still need EUS in the workup of patients with early esophageal neoplasia? A retrospective analysis of 131 cases |
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