441 Combination of Dysphagia and Exophytic Esophageal Carcinoma Strongly Correlates With Advanced Disease Based on EUS: A Possible Clinical Shortcut?

Abstract

INTRODUCTION: Since the 1960’s, the incidence of esophageal cancer has increased steadily by 8% annually in the U.S, and has an overall 5-year survival for early stage adenocarcinoma < 15%. Combined modality of endoscopy, CT and/or CT/PET imaging, and endoscopic ultrasound (EUS) are often utilized to diagnose and stage according TNM classification. If no distant metastases are found, EUS can be used to stage regional lymph nodes and tumor depth. Historically, esophagectomy was the therapeutic mainstay, but is associated with 10% mortality and > 50% morbidity. Endoscopic therapy is now utilized in patients with Tis or T1a tumors with improved survival. We examined the likelihood of clinical symptomatology predicting esophageal carcinoma TNM stage at the time of EUS. METHODS: Our IRB approved retrospective study from January 2007 to July 2017 included 300 medical records of patients over 18 years old obtained through ICD 9&10 codes. 100 patients were randomly chosen for analysis. Patients were excluded for the following: insufficient records, caustic or hazardous exposures, acute trauma, perforation, or surgery, radiation or chemotherapy, HIV, eosinophilic esophagitis, or those undergoing Barret’s esophagus surveillance screening. Data analysis included student t-test to determine significance. RESULTS: Mean age at time of diagnosis was 64, with 77% male. Eighty-one percent of lesions were in the distal third of the esophagus. Adenocarcinoma was the predominant tumor at 81% followed by squamous cell carcinoma. Of these cancer diagnoses, 78 patients experienced either solid food or progressive dysphagia prior to endoscopy. 83% of dysphagia patients were T3 or greater by EUS [Figure 1]. There was no correlation between dysphagia symptoms and lymphadenopathy on either CT (P = 0.21) or EUS (P = 0.34). CONCLUSION: Our results show a strong association of dysphagia as a presenting symptom with advanced TNM stage at the time of EUS (P = 0.03). CT imaging techniques alone may be sufficient in individuals with dysphagia and exophytic lesion by ruling out distant metastasis. Evidence gained by EUS and the associated added costs may not add clinical information to assist in management decisions with neoadjunvant therapy or esophagectomy candidacy. Further prospective study is needed to determine if EUS is warranted in individuals with dysphagia and an exophytic mass at the time of EGD, who have undergone CT staging to rule out distant metastasis.