Endosonographic examination of gastrointestinal anastomoses with suspectedlocoregional tumor recurrence

Background: Endoscopic ultrasound is considered one of the best tools for t he preoperative staging of esophageal, gastric, and rectal carcinoma. Depen ding on the individual investigator, the sensitivity of preoperative tumor staging by endosonography of the upper gastrointestinal tract (GEUS) is 80- 92% for gastric carcinoma and 86-95% for esophageal carcinoma. However, the sensitivity and specificity of endosonography for the staging of lymph nod e metastases is less accurate. The accuracy of rectal endosonography (REUS) is similar to 90% for tumor assessment and similar to 80% for the detectio n of lymph node metastases. In this study, we address the question of wheth er endosonography enables the surgeon to distinguish scar tissue, which is rather homogeneous and echo-rich, from changes such as an anastomositis or a locoregional tumor recurrence, which are typically noninhomogeneous and e cho-poor. Methods: During a 24-months period, we studied patients enrolled in a speci al tumor follow-up care program by either upper gastrointestinal (GEUS, n = 37 patients) or rectal endosonography (REUS, n = 49 patients) for exclusio n of a locoregional tumor recurrence. In each patient, local tumor recurren ce was suspected because of either medical history, clinical examination, o r other diagnostic procedures. Results: As in previous studies, our retrospective analysis revealed that e ndosonography has a high sensitivity in the detection of local tumor recurr ences (>90%) for both GEUS and REUS. Conclusion: Endosonography is a highly accurate means of detecting local tu mor recurrence.