Abstracts
2000 Digestive Disease Week

# 2256 The Utility of Preoperative Endoscopic Ultrasound Staging of Esophageal Cancer in a Surgical Practice.
David J. Bowrey, Jan Johansson, Jeffrey H. Peters, Reginald V. Lord, Jeffrey A. Hagen, Steven R. Demeester, Christopher Streets, Dennis Blom, Mike Wood, Cedric G. Bremner, Tom R. Demeester, Los Angeles, CA

Introduction: Accurate preoperative staging is important for optimum management of patients with esophageal cancer. Endosonography has been reported to be the most accurate method for locoregional disease staging in these patients. Although endosonography is performed by radiologists or gastroenterologists in many institutions, it is performed exclusively by surgeons in our department. The aim of this study was to determine the accuracy of endosonography for the staging of locoregional disease for patients with esophageal cancer in a foregut surgery department. Methods: The endosonographic findings were compared to the resection specimen histopathologic findings for 91 patients with esophageal carcinoma. Patients who had received preoperative chemoradiotherapy were excluded. Endosonography was performed using an Olympus UM-20 echoendoscope with a scanning frequency between 7.5 and 12 MHz. Results: The positive predictive value of esophageal endosonography was high for T1 (93%) and T3 carcinoma (84%), but was low for T2 carcinoma (56%). The accuracy of endoscopic ultrasound was 89% for T1, 82% for T2, and 85% for T3 tumors. When there was discordance between endosonography and histology (20 patients), ultrasound was more likely to overestimate tumor depth (13/20 patients). For the 34 pN0 and the 57 pN1 patients, the sensitivity, specificity and accuracy of endosonography were 78%, 66% and 74%, respectively. Conclusion: Endosonography is a valuable staging modality for patients with esophageal cancer. Endosonography correctly predicted pT1 tumors in 93% of patients and pT3 tumors in 84%. Endosonographic findings are reliable for treatment planning for these patients, with more conservative surgery recommended for those with early disease and neoadjuvant therapy followed by surgery for those with later stage disease. The accuracy of esophageal endosonography when performed by surgeons is similar to that achieved by non-surgeons.