Mb. Wallace et al., Dilation of malignant esophageal stenosis to allow EUS guided fine-needle aspiration: safety and effect on patient management, GASTROIN EN, 51(3), 2000, pp. 309-313
Background: Endoscopic ultrasonography (EUS) with fine-needle aspiration id
entifies patients with esophageal cancer who are unlikely to be cured by su
rgery. In approximately 30% of patients the staging procedure cannot be com
pleted without dilation of an obstructing tumor.
Methods: All EUS examinations for esophageal cancer requiring dilation from
July 1995 to December 1998 were included. Yield was defined as newly diagn
osed metastatic (celiac lymph nodes) or locally invasive disease that could
not have been detected without dilation.
Results: EUS was performed in 132 patients. Forty-two (32%) required 44 dil
ations, No complications occurred. Of the 42 patients with obstruction, 18
(43%) had celiac adenopathy of which 7 had malignant cells confirmed histol
ogically, 3 had benign adenopathy, and 8 did not undergo fine-needle aspira
tion due to T4 stage disease (5) or intervening vessels (3), Two patients w
ere upstaged after successful dilation from T2 N1 Mx to T4 N1 Mx and from T
3 Nx Mx to T3 N1 M1. Overall, dilation allowed detection of advanced diseas
e in 8 of 42 (19%) patients. Dilation to 11 to 12.8 mm was insufficient (36
% success rate) to complete EUS compared with dilation to 14 to 16 mm (87%,
p < 0.01).
Conclusion: Dilation of obstructing esophageal tumors allows identification
of a large number of patients with advanced stage malignancy. Dilation to
14 to 16 mm is sufficient for complete staging in almost all patients.