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Routine staging with endoscopic ultrasound in patients with obstructing esophageal cancer and dysphagia rarely impacts treatment decisions

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Abstract

Background

Endoscopic ultrasound (EUS) has been routinely utilized for the locoregional staging of esophageal cancer. One important aspect of clinical staging has been to stratify patients to treatment with neoadjuvant chemoradiation or primary surgical therapy. We hypothesized that EUS may have a limited impact on clinical decision making in patients with dysphagia and obstructing esophageal masses.

Methods

This retrospective cohort study included all patients with esophageal adenocarcinoma undergoing esophageal EUS between July 2008 and September 2013. Dysplastic Barrett’s esophagus without invasive adenocarcinoma or incomplete staging was excluded. Patient demographics, endoscopic tumor characteristics, the presence of dysphagia, sonographic staging, and post-EUS therapy were recorded. Pathologic staging for patients who underwent primary surgical therapy was also recorded. Locally advanced disease was defined as at least T3 or N1, as these patients are typically treated with neoadjuvant therapy.

Results

Two hundred sixteen patients underwent EUS for esophageal adenocarcinoma, with 147 (68.1%) patients having symptoms of dysphagia on initial presentation. Patients with dysphagia were significantly more likely to have locally advanced disease on EUS than patients without dysphagia (p < 0.0001). Additionally, 145 (67.1%) patients had a partially or completely obstructing mass on initial endoscopy, of which 136 (93.8%) were locally advanced (p < 0.0001 vs. non-obstructing lesions).

Conclusions

An overwhelming majority of patients presenting with dysphagia and/or the presence of at least partially obstructing esophageal mass at the time of esophageal cancer diagnosis had an EUS that demonstrated at least locally advanced disease. The present study supports the hypothesis that EUS may be of limited benefit for management of esophageal cancer in patients with an obstructing mass and dysphagia.

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Acknowledgements

Research reported in this publication was supported by the National Institutes of Health Awards T32-CA090223.

Author contributions

SAM, KAP, and JPW were involved in study conception and design. SAM, SE-D, SGK, KAP, and JPW acquired the data. SAM, SE-D, SGK, KAP, and JPW analyzed and interpreted the data. SAM, KAP, and JPW drafted the manuscript. SAM, SE-D, SGK, KAP, and JPW critically revised the manuscript for important intellectual content. SAM, and KAP performed all the statistical analyses.

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Authors and Affiliations

  1. General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Sara A. Mansfield & Kyle A. Perry

  2. Section of Advanced Endoscopy, Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, Columbus, OH, 43210, USA

    Samer El-Dika, Somashekar G. Krishna & Jon P. Walker

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  1. Sara A. Mansfield
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  2. Samer El-Dika
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Correspondence to Jon P. Walker.

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Disclosures

Sara A. Mansfield, Samer El-Dika, Somashekar G. Krishna, Kyle A. Perry, and Jon P. Walker have no conflicts of interest or financial ties to disclose.

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Mansfield, S.A., El-Dika, S., Krishna, S.G. et al. Routine staging with endoscopic ultrasound in patients with obstructing esophageal cancer and dysphagia rarely impacts treatment decisions. Surg Endosc 31, 3227–3233 (2017). https://doi.org/10.1007/s00464-016-5351-6

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  • DOI: https://doi.org/10.1007/s00464-016-5351-6

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