MALIGNANT ESOPHAGEAL STRICTURES - STAGING ACCURACY OF ENDOSCOPIC ULTRASONOGRAPHY

The prognosis for patients with carcinoma of the esophagus remains poo r despite aggressive combination therapies and radical surgical resect ions. Accuracy of staging esophageal carcinoma by endoscopic ultrasono graphy is unmatched by that of any other modality. Of patients with es ophageal carcinoma, 20% to 36% present with high-grade malignant stric tures that preclude passage of the echoendoscope. Aggressive wire-guid ed dilation followed by complete endoscopic ultrasonographic assessmen t or endosonography limited to the proximal aspect of the stricture ha s been used in staging these patients. Of 204 patients with esophageal carcinoma, 51 (25%) presented with high-grade malignant strictures, d efined as stenosis precluding passage of the echoendoscope without pri or dilation. Thirty-nine of the 51 patients were treated by esophageal resection. Twenty-one of these patients underwent preoperative stagin g using wire-guided dilation followed by endoscopic ultrasonography, w hereas 18 underwent limited endosonographic staging. Correct preoperat ive assessment of depth of tumor invasion (T stage) was obtained in 33 % (7 of 21) of the former group and 28% (5 of 18) of the latter group. Advanced tumor stage (stage III or IV) was present in 90% (35 of 39) of patients presenting with high-grade strictures, indicating a poor p rognosis for those patients. The current study demonstrates that (1) a pproximately 25% of all patients with esophageal carcinoma present wit h high-grade strictures that preclude passage of the echoendoscope wit hout prior dilation, (2) the majority of patients with high-grade mali gnant strictures present with advanced disease (stage III or IV), and (3) because of the low accuracy of endoscopic ultrasonography in stagi ng high-grade strictures, the need to subject such patients to invasiv e staging studies is questionable.