Ls. Kim et J. Koch, Do we practice what we preach? Clinical decision making and utilization ofendoscopic ultrasound for staging esophageal cancer, AM J GASTRO, 94(7), 1999, pp. 1847-1852
OBJECTIVES: Endosonography is accurate for staging esophageal cancer. Howev
er, whether detailed staging impacts clinical decision making, whether endo
sonography is perceived as a useful modality, and what factors influence th
e utilization of endosonography have not been studied.
METHODS: One hundred gastroenterologists were surveyed about staging and ma
nagement of esophageal cancer, including: 1) management by stage; 2) percei
ved usefulness of endosonography; 3) availability of endosonography; and 4)
number of patients referred.
RESULTS: Clinical decisions varied by incremental differences in tumor stag
e. However, only 27 of 66 respondents (40.9%) judged endosonography to be v
ery useful or essential for the evaluation of esophageal cancer and only 22
(33.3%) had referred a patient. Perceived usefulness and availability were
independent factors strongly associated with referral for endosonography.
Among 18 respondents to whom endosonography was available and who considere
d it useful, 14 (77.9%) had referred a case. In contrast, a conservative ma
nagement was not associated with either perceived usefulness of or referral
for endosonography.
CONCLUSIONS: Clinicians recognize the importance of detailed staging for ma
nagement of esophageal cancer. Despite this, they underestimate the utility
of endosonography and fail to refer patients for appropriate evaluation. L
ack of perceived usefulness and unavailability are important independent ba
rriers to utilization of endosonography in clinical practice. (Am J Gastroe
nterol 1999;94:1847-1852. (C) 1999 by Am. Coll. of Gastroenterology).