Impact of endoscopic ultrasonography (EUS) on surgical decision-making in upper gastrointestinal tract cancer: An international multicenter study

Mortensen, Michael Bau; Edwin, Bjørn; Liedman, Bengt; Nielsen, Henning Overgaard; Hovendal, Claus

doi:10.1007/s00464-006-9029-3

Cited by 33 publications

(22 citation statements)

References 14 publications

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“…Its role in determining unresectability must be validated by open operative assessment. EUS is also recommended in some centers as a routine preoperative staging tool 25 but was unavailable to this patient group. EUS may have a role in further discriminating tumor operability.…”

Section: Discussionmentioning

confidence: 99%

Surrogate Markers of Resectability in Patients Undergoing Exploration of Potentially Resectable Pancreatic Adenocarcinoma

Ong

Garcea

Thomasset

et al. 2008

Journal of Gastrointestinal Surgery

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Despite extensive preoperative staging, a significant number of pancreatic cancers are unresectable at surgical exploration. Patients undergoing pancreatic exploration with a view to resection were studied and comparisons are then made between those undergoing resection and a bypass procedure to identify surrogate markers of unresectability. One hundred thirteen consecutive patients underwent pancreatic exploration for head-of-pancreas (HOP) adenocarcinoma with curative intent. Fifty-five underwent pancreaticoduodenectomy and 58 underwent a bypass procedure. Student's t test, receiver operator characteristics (ROC) and logistic regression were used to compare the predictive value of preoperative patient variables collected retrospectively. The bypass group had a significantly higher median CA19.9 than the resection group (P = 0.003). Platelet count and neutrophil-lymphocyte ratio (NLR) were also significantly different (P = 0.013 and P = 0.026, respectively). ROC analysis indicated that age < or =65, platelet count >297 x 10(9)/l, CA19.9 < or =473 Ku/l, and CA19.9-bilirubin ratio were predictive variables for resectable disease. NLR and CA19.9-bilirubin ratio had specificity values of 92.9 and 97.0%, respectively. From logistic regression, a raised CA19.9 was found to be an independent risk factor for unresectable disease (P = 0.031). A significant proportion of patients with HOP adenocarcinoma are understaged preoperatively. Preoperative serology including platelet count, NLR, CA19.9, and CA19.9-bilirubin ratio may be used as additional discriminators of resectability particularly for high-risk patients.

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Section: Discussionmentioning

confidence: 99%

Surrogate Markers of Resectability in Patients Undergoing Exploration of Potentially Resectable Pancreatic Adenocarcinoma

Ong

Garcea

Thomasset

et al. 2008

Journal of Gastrointestinal Surgery

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“…15 An international multicenter study that compared EUS staging of esophageal cancer to CT alone showed that the additional information obtained by EUS changed patient management in one-third of cases with the majority (85%) of these changes being the advocation of nonsurgical and palliative measures due to identification of advanced disease. 16 …”

Section: Discussionmentioning

confidence: 99%

Endoscopic ultrasonography in esophageal cancer leads to improved survival rates: Results from a population‐based study

Wani

Das

Rastogi

et al. 2014

Cancer

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Background and Aims The advantages of endoscopic ultrasound (EUS) and computed tomography-positron emission tomography (CT-PET) in relation to survival in esophageal cancer (EC) patients are unclear. This study aimed to assess the effect of EUS, CT-PET and its combination on overall survival relative to cases not receiving these procedures. Methods Patients aged ≥ 66 years diagnosed with EC were identified in the Surveillance, Epidemiology, and End Results-Medicare linked database. Cases were split into four analytic groups: EUS only (n=318), CT-PET only (853), EUS+CT-PET (189) and “no EUS or CT-PET” (2,439). Survival times were estimated by Kaplan-Meier method and compared by using log-rank test for each group versus the “no EUS or CT-PET” group. Multivariable Cox proportional hazards models were used to compare 1, 3 and 5-year survival rates. Results Kaplan-Meier analyses showed that patients undergoing EUS, CT-PET and EUS+CT-PET had improved survival for all stages, all compared with “no EUS or CT-PET”, with the exception of stage 0 disease. Receipt of EUS increased the likelihood of receiving endoscopic therapies, esophagectomy and chemoradiation. Multivariable Cox proportional hazards models showed that receipt of EUS was a significant predictor for improved 1-year (HR 0.49, 95% CI 0.39–0.59, p<0.0001), 3-year (HR 0.57, 95% CI 0.48–0.66, p<0.0001) and 5-year (HR 0.59, 95% CI 0.50–0.68) survival. Similar results were noted when results were stratified based on histology, as well as for CT-PET and EUS+CT-PET groups. Conclusions Receipt of either EUS or CT-PET alone in EC patients is associated with improved 1, 3 and 5-year survival. Future studies should identify barriers to dissemination of these staging modalities.

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“…Endoscopic ultrasound (EUS) is reliable in the diagnosis and staging of gastrointestinal malignancies and has become an indispensable evaluation in patients who are suspected of having submucosal tumors of the upper gastrointestinal tract[7,8]. Specimens obtained with a standard endoscopic biopsy rarely provide a confirmative diagnosis because lesions in the submucosa are difficult to reach directly with forceps.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic ultrasound-guided cutting of holes and deep biopsy for diagnosis of gastric infiltrative tumors and gastrointestinal submucosal tumors using a novel vertical diathermic loop

Liu¹,

Yang²

2017

WJG

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AIMTo report on a more accurate diagnostic possibility offered by endoscopic ultrasound-guided cutting of holes and deep biopsy (EUS-CHDB) for pathologic diagnosis of gastric infiltrative tumors and gastrointestinal submucosal tumors.METHODSTen consecutive patients who were suspected of having gastric invasive tumors or gastrointestinal submucosal tumors underwent EUS-CHDB with a novel vertical diathermic loop. We reviewed their medical data and analysed the effectiveness and safety of this new method. The final diagnosis was based on the surgical pathology or clinical/imaging follow-up.RESULTSEUS-CHDB was performed successfully in all the ten patients. Neither severe haemorrhage nor perforation occurred in any patient. Among the ten patients, there were three cases of gastric linitis plastica, one case of gastric lymphoma, five cases of gastrointestinal stromal tumors (GISTs), and only one case of chronic non-atrophic gastritis. That is, nine (90%) of the cases treated by EUS-CHDB showed positive findings.CONCLUSIONEUS-CHDB may be a technically feasible and safe option for patients with gastric infiltrative tumors or gastrointestinal submucosal tumors. EUS-CHDB may be used as a remedial or even preferred biopsy method for submucosal lesions.

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Impact of endoscopic ultrasonography (EUS) on surgical decision-making in upper gastrointestinal tract cancer: An international multicenter study

Cited by 33 publications

References 14 publications

Surrogate Markers of Resectability in Patients Undergoing Exploration of Potentially Resectable Pancreatic Adenocarcinoma

Surrogate Markers of Resectability in Patients Undergoing Exploration of Potentially Resectable Pancreatic Adenocarcinoma

Endoscopic ultrasonography in esophageal cancer leads to improved survival rates: Results from a population‐based study

Endoscopic ultrasound-guided cutting of holes and deep biopsy for diagnosis of gastric infiltrative tumors and gastrointestinal submucosal tumors using a novel vertical diathermic loop

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