Department of Gastroenterology and Hepatology, Academic Medical Center Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
Gastrointest Endosc. 2011 Apr;73(4):662-8. doi: 10.1016/j.gie.2010.10.046. Epub 2011 Jan 26.
EUS is often used for locoregional staging of early esophageal neoplasia. However, its value compared with that of endoscopic examination and diagnostic endoscopic resection (ER) may be questioned because diagnostic ER allows histological assessment of submucosal invasion and other risk factors for lymph node metastasis, eg, poor differentiation/lymphovascular invasion.
To evaluate how often patients were excluded from endoscopic treatment of esophageal neoplasia based on EUS findings.
Retrospective cohort study.
Tertiary care institution.
Patients with early esophageal neoplasia.
EUS, diagnostic ER.
Number of patients excluded from endoscopic treatment based on EUS results.
A total of 131 patients were included (98 men, 33 women; age 66 ± 13 years). In 105 of 131 patients (80%), EUS findings were unremarkable. In 25 of 105 patients (24%), diagnostic ER showed submucosal invasion (n = 17), deep resection margins positive for cancer (n = 2, confirmed at surgery), or poor differentiation/lymphovascular invasion (n = 6). In 26 of 131 patients (20%), EUS findings raised the suspicion of submucosal invasion and/or lymph node metastasis. In the 14 of 26 patients (54%) with abnormal EUS findings, endoscopy results were unremarkable. Diagnostic ER showed submucosal invasion in 7 of 14 (50%) patients, whereas no lymph node metastasis risk factors were found in 7 of 14 patients (50%), who subsequently underwent curative endoscopic treatment. In 12 of 26 patients (46%) with abnormal EUS, endoscopy also raised doubts on whether curative endoscopic treatment could be achieved. After diagnostic ER, no risk factors for lymph node metastasis were found in 3 of 12 patients (25%).
Retrospective study.
This study shows that EUS has virtually no clinical impact on the workup of early esophageal neoplasia and strengthens the role of diagnostic ER as a final diagnostic step.
EUS 常用于早期食管肿瘤的局部区域分期。然而，与内镜检查和诊断性内镜切除术（ER）相比，其价值可能受到质疑，因为诊断性 ER 允许对黏膜下浸润和其他淋巴结转移的危险因素（如低分化/血管淋巴管浸润）进行组织学评估。
评估有多少患者因 EUS 结果而被排除在食管肿瘤的内镜治疗之外。
回顾性队列研究。
三级医疗机构。
患有早期食管肿瘤的患者。
EUS、诊断性 ER。
根据 EUS 结果排除内镜治疗的患者数量。
共纳入 131 例患者（98 例男性，33 例女性；年龄 66±13 岁）。在 131 例患者中，有 105 例（80%）EUS 检查结果无异常。在 105 例患者中有 25 例（24%），诊断性 ER 显示黏膜下浸润（n=17）、深切缘癌阳性（n=2，手术证实）或低分化/血管淋巴管浸润（n=6）。在 131 例患者中，有 26 例（20%）EUS 检查结果提示黏膜下浸润和/或淋巴结转移的可能性。在 26 例异常 EUS 检查结果的患者中，有 14 例（54%）内镜检查结果无异常。诊断性 ER 显示 14 例患者中有 7 例（50%）存在黏膜下浸润，而 14 例患者中未发现淋巴结转移的危险因素（50%），随后进行了根治性内镜治疗。在 26 例异常 EUS 检查结果的患者中，有 12 例（46%）内镜检查也对是否可以进行根治性内镜治疗产生了怀疑。在诊断性 ER 后，有 3 例（25%）患者未发现淋巴结转移的危险因素。
回顾性研究。
本研究表明，EUS 对早期食管肿瘤的检查几乎没有临床影响，进一步证实了诊断性 ER 作为最终诊断步骤的作用。
