COMBINED ENDOSCOPIC ULTRASONOGRAPHY AND LAPAROSCOPIC ULTRASONOGRAPHY IN THE PRETHERAPEUTIC ASSESSMENT OF RESECTABILITY IN PATIENTS WITH UPPER GASTROINTESTINAL MALIGNANCIES

Background: Even though endoscopic ultrasonography (EUS) has improved the pretherapeutic staging and assessment of resectability in patients with upper gastrointestinal (GI) tract malignancies, a considerable n umber of patients still have to undergo unnecessary explorative laparo tomy to obtain the final assessment of resectability. The aim of the p resent study was to evaluate laparoscopic ultrasonography (LUS) and th e combination of EUS and LUS in the pretherapeutic study of these pati ents with special reference to resectability. Methods: Each of 44 pati ents with esophageal, gastric, or pancreatic cancer was assigned to a treatment-related resectability group based on five different imaging modalities: computer tomography (CT) + ultrasonography (US), EUS, lapa roscopy, LUS, and EUS + LUS. The findings with these imaging modalitie s were compared with intraoperative findings. Results: Overall group a ssignment accuracy showed significantly better results for EUS, LUS, a nd EUS + LUS than for CT + US and laparoscopy. EUS + LUS identified al l non-resectable patients, whereas the sensitivity of CT + US, laparos copy, and EUS were 14%, 36%, and 79%, respectively. Median time consum ption for each EUS, laparoscopy, or LUS procedure was less than 25 min , and no complications were seen during or after the EUS, laparoscopy, or LUS procedures. Conclusion: preliminary experience with the combin ation of EUS and LUS for pretherapeutic assessment of upper GI tract m alignancies showed that this combination was superior to CT + US, lapa roscopy, and EUS. EUS + LUS correctly identified all non-resectable pa tients, but two overstaged patients also indicated the need for larger prospective studies to identify the indications and the limitations o f this new approach.