Endoscopic Ultrasonography of the Esophagus

Abstract

Endoscopic ultrasonography (EUS) is a generally accepted technique for the preoperative staging of malignant tumors in the upper and lower gastrointestinal tracts. In particular, EUS has been considered the method of choice in diagnosing esophageal carcinoma due to the relative ease in performing the examination and the accuracy of staging based on high-resolution ultrasonic imaging from within the lumen of the esophagus. This comprehensive review covers currently available EUS instruments, image characteristics of esophageal carcinoma, and images by the recently introduced miniprobe scanner. The role of the method in diagnosing superficial esophageal carcinoma and the possible treatment by endoscopic mucosal resection of this particular disease entity are discussed.

The useful combination of a higher frequency miniprobe and endoscopic submucosal dissection for the treatment of T1 esophageal cancer

“…Clinically, overstaging is a more serious problem than understaging because overstaging, such as endosonographically uM3-uSM1 but pathologically pM1-pM2, may lead to an esophagectomy, which is undoubtedly an unnecessary treatment. In our study, overstaging occurred in four of 14 T1 cancer patients (29%), in agreement with other studies (4-35%), even with the usage of a higher frequency miniprobe [8,12,16,17,22,23]. An ESD excises a larger disk of the esophageal wall than endoscopic mucosal resection, and it provides an en bloc specimen with a single application for histologic review that would otherwise be resected by a piecemeal method [21].…”

Vertical and horizontal growth features of superficial esophageal squamous cell carcinomas: histopathological evaluation of endoscopically resected specimens

“…In recent years endoscopic ultrasonography and magnetic resonance imaging have been also applied for the diagnosis of esophageal carcinomas [4,26]. In our hospital endoscopic ultrasonography has been performed for almost all cases, especially for m3 and sm cases.…”

“…For selection of EMR as a first line treatment for intramucosal esophageal carcinomas it is important to evaluate invasion depth accurately by preoperative endoscopic examination and to discriminate submucosal from intramucosal cases. In recent years endoscopic ultrasonography has been also applied for the diagnosis of esophageal carcinoma [4]. However, to our knowledge, differentiation between intramucosal carcinomas and submucosal ones is still difficult, and pathological findings in the literature for the development of SESCCs, especially from studies using EMR specimens, are limited.…”

Effect of surveillance of Barrett's oesophagus on the clinical outcome of oesophageal cancer

“…However, accurate preoperative staging of T1 tumours is essential if such an approach is to be used. Currently available endoscopic ultrasound probes are not sufficiently sensitive to distinguish between intramucosal and submucosal tumours 51,52 . In the present study, 13 of the 17 patients in the surveillance programme had T1 tumours; seven were submucosal and one of these was node positive.…”