Published online Feb 7, 2017. doi: 10.3748/wjg.v23.i5.751
Peer-review started: September 20, 2016
First decision: October 10, 2016
Revised: November 23, 2016
Accepted: December 21, 2016
Article in press: December 21, 2016
Published online: February 7, 2017
Despite substantial efforts at early diagnosis, accurate staging and advanced treatments, esophageal cancer (EC) continues to be an ominous disease worldwide. Risk factors for esophageal carcinomas include obesity, gastroesophageal reflux disease, hard-alcohol use and tobacco smoking. Five-year survival rates have improved from 5% to 20% since the 1970s, the result of advances in diagnostic staging and treatment. As the most sensitive test for locoregional staging of EC, endoscopic ultrasound (EUS) influences the development of an optimal oncologic treatment plan for a significant minority of patients with early cancers, which appropriately balances the risks and benefits of surgery, chemotherapy and radiation. EUS is costly, and may not be available at all centers. Thus, the yield of EUS needs to be thoughtfully considered for each patient. Localized intramucosal cancers occasionally require endoscopic resection (ER) for histologic staging or treatment; EUS evaluation may detect suspicious lymph nodes prior to exposing the patient to the risks of ER. Although positron emission tomography (PET) has been increasingly utilized in staging EC, it may be unnecessary for clinical staging of early, localized EC and carries the risk of false-positive metastasis (over staging). In EC patients with evidence of advanced disease, EUS or PET may be used to define the radiotherapy field. Multimodality staging with EUS, cross-sectional imaging and histopathologic analysis of ER, remains the standard-of-care in the evaluation of early esophageal cancers. Herein, published data regarding use of EUS for intramucosal, local, regional and metastatic esophageal cancers are reviewed. An algorithm to illustrate the current use of EUS at The University of Texas MD Anderson Cancer Center is presented.
Core tip: Endoscopic ultrasound (EUS) is not necessary or adds little in management of many cases, such as, in patients with distant metastases or following pre-operative (neoadjuvant) chemoradiotherapy. EUS is the most sensitive test to exclude local tumor invasion and regional nodal disease that would make endoscopic resection (ER) unsafe or unnecessary. Thus, for early esophageal cancer staging, EUS followed by ER and histopathologic analysis, remains the standard-of-care. For a minority of locally advanced cancers, EUS-fine-needle aspiration can define the radiotherapy field by providing tissue samples of suspicious lymph nodes that are remote from the primary tumor.