VALUE OF ENDOSCOPIC ULTRASONOGRAPHY FOR ASSESSMENT OF PATIENTS PRESENTING ELEVATED TUMOR-MARKER LEVELS AFTER SURGERY FOR COLORECTAL CANCERS

Background and Study Aims: This prospective study was undertaken to ev aluate the role of endoscopic ultrasound (EUS) in patients presenting with elevated tumor marker levels (CEA, CA 19-9) after surgery for col orectal cancer, Patients and Methods: During a 26-month period, coloni c EUS was performed in 21 patients who had undergone surgical treatmen t for colorectal cancers. All patients presented with elevated tumor m arker levels at the time of examination but all other diagnostic proce dures (US, CT scan of the abdomen and thorax, bone scintigraphy and co lonoscopy) did not demonstrate recurrence, Colonic EUS was performed u sing a linear convex probe (echoendoscopes Pentax: FG 32 UA, 36 U, 38 UX), In cases with normal findings on colonic EUS, upper gastrointesti nal tract EUS was also performed. Results: 21 colonic EUS and six uppe r gastrointestinal tract EUS examinations were performed. Of 21 coloni c EUS examinations, 15 showed either local recurrence (n = 9) or perit oneal carcinomatosis (n = 6) and six EUS-guided biopsies were performe d. Of these 15 patients, 13 were operated on and results were confirme d in 12 of 13 patients, namely in 8/9 cases with suspected anastomotic recurrence and in all four operated cases with presumed peritoneal ca rcinomatosis. EUS-guided biopsy had diagnosed three of the four cases before. Upper GI EUS was performed in the six cases with normal coloni c EUS; two cases showed mediastinal lymph nodes and one showed celiac lymph nodes. EUS-guided biopsy confirmed the malignancy of these nodes . For the diagnosis of recurrence, sensitivity, specificity and accura cy of lower plus upper gastrointestinal EUS were 94.4%, 66.6% and 90.4 % respectively. Conclusion: EUS of the colon and - in selected cases - also of the upper gastrointestinal tract is quite useful in this clin ical setting, Further studies are needed to evaluate the impact of EUS on outcome in larger patient numbers.