Increased rate of complete EUS staging of patients with esophageal cancer using the nonoptical, wire-guided echoendoscope,☆☆

Dr. Mallery was the recipient of the 1997 ASGE/Olympus Advanced Endoscopic Training Scholarship.
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Abstract

Background: Incomplete endoscopic ultrasound (EUS) staging procedures in patients with esophageal cancer due to obstructing malignant strictures are prone to underestimate T stage and cannot detect celiac adenopathy. EUS staging in the setting of stenotic malignancies using the large caliber echoendoscope has been complicated by esophageal perforation. We report on the clinical utility of a newly developed, wire-guided echoendoscope for the complete staging of patients with esophageal cancer. Methods: Pretreatment EUS examinations performed for esophageal cancer staging were evaluated and the ability to traverse the esophagus and examine the celiac axis were documented. Outcomes before and after the availability of the wire-guided echoendoscope were compared. Results: One hundred thirty consecutive examinations were evaluated—100 before and 30 after the introduction of the wire-guided echoendoscope. Complete staging was accomplished in 60 of 100 (60%) cases before and 27 of 30 (90%) after its introduction (p = 0.002). The wire-guided echoendoscope was used in 14 of the 30 cases. Despite a trend toward fewer stage T4 tumors, metastatic disease was documented significantly more frequently after the introduction of the esophagoprobe (34% vs. 11%, p = 0.002). There were no complications. Conclusions: The introduction of the wire-guided echoendoscope markedly reduced the occurrence of incomplete esophageal cancer staging and improved the detection of metastatic disease. (Gastrointest Endosc 1999;50:53-7.)

Section snippets

PATIENTS AND METHODS

EUS examinations performed for esophageal cancer staging were reviewed. Patients with prior surgical resection, chemotherapy or radiotherapy were excluded. The remaining patients were divided into two groups. Group I consisted of patients whose EUS examinations were performed before the availability of the wire-guided echoendoscope (Olympus MH-908; Olympus America, Inc., Melville, N.Y.). These examinations were performed using the Olympus GF-UM20 echoendoscope (tip diameter 13.2 mm) between

RESULTS

There were 100 patients in group I and 30 in group II. The demographic characteristics of these two groups are summarized in Table 2.

. Patient demographics

Empty CellGroup 1Group 2Empty Cell
Empty CellBefore MH-908 (N = 100)After MH-908 (N = 30)Total (N = 130)
Mean age (yr) (range)64 (32-87)63 (45-78)64 (32-87)
Gender (M/F)81:1923:7104:26
Diagnosis
 Adenocarcinoma68%75%69%
 Squamous cell carinoma29%25%28%
 Undifferentiated carcinoma2%2%
 Small cell1%1%
The wire-guided echoendoscope was used in 14 of the 30 patients in group II. No

DISCUSSION

Three methods have been proposed for the endosonographic evaluation of high-grade malignant esophageal strictures. The first involves the use of endoscopic dilation before EUS. This method is controversial. It has been reported to be safe by some investigators21 and associated with a prohibitively high rate (24%) of perforation by others.16 Although some endosonographers have also recommended the avoidance of dilation,10 others recommend sequential dilation over several days.3 We found the

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  • Cited by (64)

    Reprint requests: Jacques Van Dam, MD, PhD, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115.

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