Endoscopic Ultrasound Does Not Accurately Stage Early Adenocarcinoma or High-Grade Dysplasia of the Esophagus

Young, Patrick E.; Gentry, Andrew; Acosta, Ruben D.; Greenwald, Bruce D.; Riddle, Mark S.

doi:10.1016/j.cgh.2010.08.020

Cited by 125 publications

(69 citation statements)

References 52 publications

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“…However, because of its lower frequency, conventional EUS does not allow accurate visualization of the muscularis mucosa [36]. Studies have shown that there may be thickening and duplication of the muscularis mucosa in patients with Barrett's esophagus.…”

Section: Early Esophageal Cancermentioning

confidence: 99%

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Esophageal Cancer

Khanna¹,

Lightdale²

2015

ERCP and EUS

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Section: Early Esophageal Cancermentioning

confidence: 99%

“…EUS is better for T3 and T4 tumors with 86 % accuracy for T4. Staging accuracy may be less for superficial tumors (T1) because the low frequency used with the echoendoscope impairs visualization of the muscularis mucosa [36]. EUS also offers the ability to assess for regional lymph node disease.…”

Section: Endoscopic Ultrasoundmentioning

confidence: 99%

Esophageal Cancer

Khanna¹,

Lightdale²

2015

ERCP and EUS

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“…However, a meta-analysis of papers comparing endoscopic ultrasound and surgical or endoscopic mucosal resection staging demonstrated that endoscopic ultrasound predicted accurate depth of tumor invasion in only 56% of patients. 2 Therefore, especially if endoscopic treatment is contemplated, staging should include endoscopic mucosal resection, and any indication of submucosal invasion should lead to recommendation for surgical resection in appropriate candidates.…”

Section: T1b (Submucosal) and T2 Cancermentioning

confidence: 99%

“…Accuracy of endoscopic ultrasound increases with increasing depth of invasion. 1 Endoscopic ultrasound has less overall accuracy in T1 disease, 2 and overall accuracy of endoscopic ultrasound assessment decreases dramatically after neoadjuvant therapy. 3 Endoscopic ultrasound assessment can also be limited when dense malignant strictures prohibit a complete assessment.…”

mentioning

confidence: 99%

Update on Staging and Surgical Treatment Options for Esophageal Cancer

Low

2011

Journal of Gastrointestinal Surgery

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“…Endoscopic ultrasound provides accurate information with respect to depth of invasion (T status), but its ability to discriminate subtle differences in T1 disease, i.e. T1a versus T1b, is less exact [5]. Endoscopic ultrasound's ability to provide accurate staging information after neoadjuvant therapy is limited [6].…”

Section: Staging and Preoperative Assessmentmentioning

confidence: 99%

Evolution in Surgical Management of Esophageal Cancer

Low¹

2013

Dig Dis

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Esophageal resection remains the primary treatment for local regional esophageal cancer, although its role in superficial (T1A) cancers and squamous cell cancer is in evolution. Mortality associated with esophagectomy has historically been high but is improving with the current expectation of in-hospital mortality rates of 2-4% in high-volume centers. Most patients with regional cancers (T2-4 N0-3) are recommended for neoadjuvant therapy, which most commonly involves radiochemotherapy. Some centers have proposed treating with definitive chemoradiation and reserving surgery for patients who have persistent or recurrent disease. ‘Salvage resections' are possible but are associated with higher levels of perioperative morbidity and mortality, and treatment decisions should routinely be based on multidisciplinary discussion in the tumor board. Although open surgical resection (both transthoracic and transhiatal operations) remain the most common approach, minimally invasive or hybrid operations are being done in up to 30% of procedures internationally. There are some indications that minimally invasive esophagectomy may decrease the incidence of respiratory complications and decrease length of stay. At this point, oncologic outcomes appear equivalent between open and minimally invasive procedures. Recent reviews from high-volume esophagectomy centers demonstrate that elderly patients can selectively undergo esophagectomy with the expectation of increased complications but similar mortality and survival to younger patients. Multiple studies confirm that quality of life following esophagectomy can be equivalent to the general population when surgery is done in experienced centers. Patients requiring surgical treatment of esophageal cancer should be referred to high-volume centers, especially those with established care pathways or enhanced recovery programs to improve outcomes including morbidity, mortality, survival, and quality of life.

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Endoscopic Ultrasound Does Not Accurately Stage Early Adenocarcinoma or High-Grade Dysplasia of the Esophagus

Cited by 125 publications

References 52 publications

Esophageal Cancer

Esophageal Cancer

Update on Staging and Surgical Treatment Options for Esophageal Cancer

Evolution in Surgical Management of Esophageal Cancer

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