Abstract
Background
Endoscopic ultrasound (EUS) is useful for detecting depth of invasion and nodal involvement in patients with early Barrett’s neoplasia (EBN), precluding endoscopic management. This study aimed to determine whether the lesion morphology of the EBN shown on high-resolution endoscopy predicts EUS and histologic tumor stage.
Methods
Retrospective series from two tertiary referral centers were studied. Patients with EBN referred for EUS evaluation before treatment were identified, and data were collected from endoscopies, a database, and case notes. All patients had high-resolution endoscopy followed by radial EUS.
Results
This study included 50 patients (22 men) with a median age of 69 years (interquartile range, 60–79 years). Visible lesions in the Barrett’s segment were described as Paris types 0–1 (n = 9), 0–IIb (n = 12), 0–IIa (n = 12), 0–IIa + IIc (n = 6), and 0–IIc (n = 5). Of the 50 patients, 46 (92%) had either EMR (n = 17), esophagectomy (n = 23), or both (n = 6). All 12 patients (100%) with Paris 0–IIb lesions had T0/T1 m staging on EUS confirmed with resection histology. The sensitivity for EUS T-staging for Paris classification was 71.4% for type 0–I, 100% for type 0–IIb, 83% for type 0–IIa, 66.7% for type 0–IIa + IIc, and 66.7% for type IIc. Overall, 8 (17%) of the 46 patients were understaged and 2 (4%) were overstaged. For detecting submucosal invasion, EUS had a sensitivity of 66%, a specificity of 93%, a negative predictive value of 85%, and a diagnostic accuracy of 84.4%.
Conclusion
Submucosal invasion is detected by EUS for 26% of patients with EBN. The value of EUS staging before resection for type 0–IIb early Barrett’s cancer (flat lesions) is limited because 100% of these lesions are limited to the mucosa. For the management algorithm in this selected cohort, the use of EUS should be reconsidered.
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References
Ganz RA, Overholt BF, Sharma VK et al (2008) Circumferential ablation of Barrett’s oesophagus that contains high-grade dysplasia: a U.S. Multicentre Registry. Gastrointest Endosc 68:41–43
Pech O, Behrens A, May A et al (2008) Long-term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with high-grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett’s oesophagus. Gut 57:1207–1213
Prasad GA, Buttar NS, Wonqkeesonq LM et al (2007) Significance of neoplastic involvement of margins obtained by endoscopic mucosal resection in Barrett’s oesophagus. Am J Gastroenterol 102:2380–2386
Stein HJ, Von Rahden BH, Feith M (2005) Surgery for early stage adenocarcinoma. J Surg Oncol 92:210–217
Manner H, May A, Pech O et al (2008) Early Barrett’s carcinoma with low-risk submucosal invasion: long-term results of endoscopic resection with curative intent. Am J Gastroenterol 103(10):2589–2597
Chemaly M, Scalone O, Durivaqe G et al (2008) Miniprobe EUS in the pretherapeutic assessment of early esophageal neoplasia. Endoscopy 40(1):2–6
Hunerbein M, Ulmer C, Handke T et al (2003) Endosonography of upper gastrointestinal tract cancer on demand using miniprobes or endoscopic ultrasound. Surg Endosc 17(4):615–619
Adrian AL, Tel HC, Cassidy MJ et al (1997) High-frequency endoluminal sonography is a sensitive modality for identification of Barrett’s metaplasia. Gastrointest Endosc 46(2):147–151
Waxman I, Ragu GS, Critchlow J et al (2006) High-frequency probe ultrasonography has limited accuracy for detecting Invasive adenocarcinoma in patients with Barrett’s oesophagus and high-grade dysplasia or intramucosal carcinoma: a case series. Am J Gastroenterol 101(8):1773–1779
May A, Gunter E, Roth F et al (2004) Accuracy of staging in early esophageal cancer using high-resolution endoscopy and high-resolution endosonography: a comparative prospective and blinded trial. Gut 53:634–640
Larghi A, Lightdale CJ, Memeo L et al (2005) EUS followed by EMR for staging of high-grade dysplasia and early cancer in Barrett’s oesophagus. Gastrointest Endosc 62:16–23
Lightdale CA, Larghi A, Rotterdam H, Okpara N et al (2004) Endoscopic ultrasonography (EUS) and endosmucosal resection (EMR) for staging and treatment of high-grade dysplasia and early adenocarcinoma (EAC) in Barrett’s esophagus (BE) (abstract). Gastrointest Endosc 59:A90
Endoscopy Classification Review Group (2005) Update on the Paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy 37:570–578
Nishi M, Omori Y, Miwa K et al (1995) Japanese classification of gastric carcinoma, 1st edn. Kanehara, Tokyo
Ahmed AN, Kochman ML, Ginsberg GG (2005) Practice patterns and the role of endoscopic ultrasound in the staging of oesophageal malignancies: a survey of physicians and surgeons. Am J Gastroenterol 100:2662–2668
Lightdale CJ, Kulkarni KG (2005) Role of endoscopic ultrasonography in the staging and follow-up of oesophageal cancer. J Clin Oncol 23:4483–4489
Chen VK, Eloubeidi MA (2004) Endoscopic ultrasound-guided fine-needle aspiration is superior to lymph node echo features: a prospective evaluation of mediastinal and peri-intestinal lymphadenopathy. Am J Gastroenterol 99:628–633
Puli SR, Reddy JB, Bechtold ML et al (2008) Staging accuracy of oesophageal cancer by endoscopic ultrasound: a metaanalysis and systematic review. World J Gastroenterol 14:1479–1490
Scotiniotis AI, Kochman ML, Lewis JD et al (2001) Accuracy of EUS in the detection of high-grade dysplasia or intramucosal carcinoma. Gastrointest Endosc 54:689–696
Buskens JC, Westerterp M, Lagarde MS et al (2004) Prediction of appropriateness of local endoscopic treatment of high-grade dysplasia and early adenocarcinoma by EUS and histopathological features. Gastrointest Endosco 60:703–710
Peters FP, Brakenhoff PMK, Curvers LW et al (2008) Histological evaluation of resection specimens obtained at 293 endoscopic resections in Barrett’s oesophagus. Gastrointest Endosco 67:604–609
Pech O, Gossner L, Manner H et al (2007) Prospective evaluation of the macroscopic types and location of early Barrett’s neoplasia in 380 lesions. Endoscopy 39:588–593
Rampado S, Bocus P, Battaglia G et al (2008) Endoscopic ultrasound accuracy in staging superficial carcinomas of the stomach. Ann Thorac Surg 85:251–256
Falk GW, Catalano ME, Sivak MV et al (1994) Endosonography in the evaluation of patients with Barrett’s and high-grade dysplasia. GIE 40:207–212
Pech O, May A, Gunter E et al (2006) The impact of endoscopic ultrasound and computerised tomography on the TNM staging of early cancer in Barrett’s oesophagus. Am J Gastro 101:2223–2229
Peters FP, Kara MA, Rosmolen WD et al (2006) Stepwise radial endoscopic resection is effective for complete removal of Barrett’s oesophagus with early neoplasia. Am J Gastroenterol 101:1449–1457
Ganz RA, Overholt BF, Sharma VK et al (2008) Circumferential ablation of Barrett’s esophagus that contains high-grade dysplasia: a U.S. Multicentre Registry. Gastrointest Endosco 68:35–40
Disclosures
Titus Thomas, David Gilbert, Phillip Kaye, and Guru Prasad Aithal have no conflicts of interest or financial ties to disclose. Krish Ragunath has received speaker honorariums, educational grants, and research support from Olympus-Keymed and Cook, UK, and Ian Penman has received educational support from Olympus-Keymed and Cook, UK.
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Thomas, T., Gilbert, D., Kaye, P.V. et al. High-resolution endoscopy and endoscopic ultrasound for evaluation of early neoplasia in Barrett’s esophagus. Surg Endosc 24, 1110–1116 (2010). https://doi.org/10.1007/s00464-009-0737-3
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DOI: https://doi.org/10.1007/s00464-009-0737-3