ABSTRACT
BACKGROUND: To fully evaluate patients with esophageal cancer by endoscopic ultrasonography (EUS), the transducer must pass through the entire tumor to the cardia to scan the celiac axis. Dilation may be necessary. Published information suggests that dilation with EUS carries a sizeable risk. METHODS: In order to assess the complication rate associated with dilation prior to EUS in patients with esophageal cancer and the clinical significance of dilation for complete EUS staging, we reviewed the records of all patients who had undergone EUS for esophageal cancer. RESULTS: Sixty-three patients underwent EUS staging of esophageal cancer. Thirty-nine (62%) had lesions through which the EUS scope was passable (Group I). Ten (16%) patients (Group II) had lesions through which an EUS scope (diameter 13 mm) was unable to pass even after dilation. Fourteen patients (22%) had lesions that were dilated to allow passage of the EUS scope (Group III). All patients in Groups II and III had confirmation of EUS staging by CT and/or surgery. In Group II, five patients had tumors defined as T4 (50%) and five as T3 (50%). In Group III, nine (64%) had T4 tumors, four (29%) had T3, and one (7.7%) had T2. No complications were encountered in any group. CONCLUSION: EUS, either alone or after dilation, is a safe procedure and the complete EUS examination with celiac node visualization adds prognostically significant information.
Subject(s)
Carcinoma/diagnostic imaging , Endoscopy, Digestive System , Esophageal Neoplasms/diagnostic imaging , Esophageal Stenosis/diagnostic imaging , Adult , Aged , Bronchoscopy , Carcinoma/complications , Carcinoma/pathology , Dilatation , Endoscopy, Digestive System/adverse effects , Endoscopy, Digestive System/instrumentation , Endoscopy, Digestive System/methods , Esophageal Neoplasms/complications , Esophageal Neoplasms/pathology , Esophageal Stenosis/etiology , Esophageal Stenosis/pathology , Esophagus/diagnostic imaging , Female , Humans , Lymphatic Metastasis , Male , Middle Aged , Neoplasm Staging , Safety , Tomography, X-Ray Computed , Ultrasonography/adverse effects , Ultrasonography/instrumentation , Ultrasonography/methodsABSTRACT
The introduction of endoscopic ultrasonography (EUS) has opened a window in the diagnosis of the perigastrointestinal lymph nodes. Initial euphoria has been sobered by the fact that false-positive and false-negative diagnoses may occur. We review here the use of EUS to stage gastrointestinal cancer, and particularly to predict the presence or absence of lymph-node metastases. The role of EUS-guided fine-needle aspiration using a radial scanner or a curved array echoendoscope is mentioned.
Subject(s)
Gastrointestinal Neoplasms/diagnostic imaging , Lymph Nodes/diagnostic imaging , Ultrasonography, Interventional , Abdomen , Biopsy, Needle , Endoscopy, Gastrointestinal/methods , Gastrointestinal Neoplasms/pathology , Humans , Lymph Nodes/pathology , Lymphatic Metastasis , Neoplasm Staging , PrognosisABSTRACT
In this article we describe the history, instrument, indications, and results of endoscopic ultrasonography (EUS) in the evaluation of perianorectal fistulas and abscesses. EUS has been reported to be helpful in the management of patients with Crohn's disease or colitis associated with fistulas and abscesses, due to its clear imaging of the leasion and valuable topographic anatomical information. Recent studies point out the relationship between EUS and electromyography. We believe EUS will become a standard procedure in the management of these complex disease processes.
