Clinical Applications of Endoscopic Ultrasound to Oncology

Oh, Young S.; Early, Dayna S.; Azar, Riad R.

doi:10.1159/000086997

Cited by 11 publications

(6 citation statements)

References 146 publications

(83 reference statements)

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“…These complications have led to the development of an anterior approach under the guidance of transcutaneous ultrasound, computed tomography or EUS ( Figure 2) [18,[30][31][32]60] . EUS allows for real-time imaging of the celiac space for CPB and CPN as well as fine needle aspiration (FNA) for diagnostic purposes and tumor staging [10,[34][35][36][37][38]71] . EUS-guided fine needle injection has been used even in patients with enternal self-expandable stents [39] .…”

Section: And Neurolysismentioning

confidence: 99%

Endoscopic ultrasonography guided celiac plexus neurolysis and celiac plexus block in the management of pain due to pancreatic cancer and chronic pancreatitis

Michaels

Draganov²

2007

WJG

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Pain is a common symptom of pancreatic disease and is frequently difficult to manage. Pain relief provided by narcotics is often suboptimal and is associated with significant side effects. An alternative approach to pain management in pancreatic disease is the use of celiac plexus block (CPB) or neurolysis (CPN). Originally performed by anesthesiologists and radiologists via a posterior approach, recent advances in endoscopic ultrasonography (EUS) have made this technique an attractive alternative. EUS guided celiac plexus block/neurolysis is simple to perform and avoids serious complications such as paraplegia or pneumothorax that are associated with the posterior approach. EUS guided CPN should be considered first line therapy in patients with pain due to pancreatic cancer. It provides superior pain control compared to traditional management with narcotics. A trend for improved survival in pancreatic cancer patients treated with CPN has been reported, but larger studies are needed to confirm this finding. At this time, the use of EUS guided CPB cannot be recommended as routine therapy for pain in chronic pancreatitis since only one-half of the patients experience pain reduction and the beneficial effect tends to be short lived. EUS guided CPB and CPN should be used as part of a multidisciplinary team approach for pain management.

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Section: And Neurolysismentioning

confidence: 99%

Endoscopic ultrasonography guided celiac plexus neurolysis and celiac plexus block in the management of pain due to pancreatic cancer and chronic pancreatitis

Michaels

Draganov²

2007

WJG

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“…5,6,[15][16][17][18] Compared to T1N0 tumors, creased depth of invasion. [19][20][21] Together, this makes the controversial treatment algorithm of cT2 even more complicated. Abbreviations: CI, confidence interval; HR, hazard ratio.…”

mentioning

confidence: 99%

“…In addition, it is unknown why the hospital location had an impact on stage discrepancy. Although several studies have demonstrated the superiority of computed tomography, positron emission tomography, and magnetic resonance imaging over EUS to diagnosis distant metastatic disease, EUS is more accurate in identifying local regional disease, with a sensitivity of 80% to 90% and specificity greater than 90%6,[19][20][21][28][29][30] The addition of fine-needle aspiration of equivocal clinical lymph nodes on EUS increases the sensitivity and T A B L E 3 Univariate and multivariable analysis for the impact of T-and N-classification discrepancy on overall survival…”

mentioning

confidence: 99%

Inaccurate pretreatment staging can impact survival in early stage esophageal adenocarcinoma

Scholer

Uppal

Chang

et al. 2020

Journal of Surgical Oncology

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Background Given the survival advantage of neoadjuvant treatment for locally advanced esophageal cancer, accurate clinical staging is necessary. The aim of this study was to assess the clinical (c) and pathologic (p) staging concordance rates for presumably early stage esophageal adenocarcinoma patients that had upfront esophagectomy (UFE) and evaluate if survival (OS) was negatively affected by inaccurate preoperative staging and subsequent treatment selection. Methods An NCDB retrospective review of nonmetastatic esophageal adenocarcinoma patients that had UFE. The rates of concordance between c and p staging system and OS were calculated. Results Of 2775 patients, most patients presented with cN0 (82.8%) and cT1 tumors (53.6%). The overall concordance between c and p staging was 78.8% for T‐classification (moderate agreement; weighted κ = 0.729; P < .001) and 78.8% for N‐classification (weak agreement; weighted κ = 0.448; P < .001). Patients that were upstaged due to a lack of concordance between T‐classification had decreased 5‐ and 10‐year OS (30% and 16%, P < .001) and those upstaged due to discordant N‐classification had decreased 5‐ and 10‐year OS (28% and 23%, P < .001).” Conclusions Preoperative staging of esophageal adenocarcinoma has moderate reliability and accuracy for predicting pT and pN classification. Up to 25% of patients have discordant clinical and pathological staging, which impacts OS.

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“…Patients with any nodal involvement (N + ) or advance tumors (T2-T4a) (Figure 1) need preoperative neoadjuvant chemoradiotherapy, whereas T1 patients with no nodal metastasis can benefit from endoscopic (Tis, T1a N0) or surgical resection (T1bN0)[10-12]. When different staging methods were compared, CT, MRI and PET-scan showed themselves to be better than EUS in evaluating distant metastasis (M), however EUS proved superiority in the detection of tumor stage (T) and lymph nodes (N)[13-16]. One method does not have to exclude the other.…”

Section: Esophageal Cancermentioning

confidence: 99%

Endoscopic ultrasound in oncology: An update of clinical applications in the gastrointestinal tract

Valero¹,

Robles-Medranda²

2017

WJGE

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An accurate staging is necessary to select the best treatment and evaluate prognosis in oncology. Staging usually begins with noninvasive imaging such as computed tomography, magnetic resonance imaging or positron emission tomography. In the absence of distant metastases, endoscopic ultrasound plays an important role in the diagnosis and staging of gastrointestinal tumors, being the most accurate modality for local-regional staging. Its use for tumor and nodal involvement in pre-surgical evaluation has proven to reduce unnecessary surgeries. The aim of this article is to review the current role of endoscopic ultrasound in the diagnosis and staging of esophageal, gastric and colorectal cancer.

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Clinical Applications of Endoscopic Ultrasound to Oncology

Cited by 11 publications

References 146 publications

Endoscopic ultrasonography guided celiac plexus neurolysis and celiac plexus block in the management of pain due to pancreatic cancer and chronic pancreatitis

Endoscopic ultrasonography guided celiac plexus neurolysis and celiac plexus block in the management of pain due to pancreatic cancer and chronic pancreatitis

Inaccurate pretreatment staging can impact survival in early stage esophageal adenocarcinoma

Endoscopic ultrasound in oncology: An update of clinical applications in the gastrointestinal tract

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