Endoscopic ultrasound in the staging of tumours of the oesophagus and gastro-oesophageal junction

Background: Modern management of upper gastro-intestinal cancer demands acc urate pre-operative staging. In continental Europe and Japan, endoscopic ul trasound (EUS) is established as the investigation of choice for local stag ing of these cancers, but British experience with this technique is limited . Methods: A retrospective review of the medical records of patients with oes ophageal or gastro-oesophageal junction tumours during our first 3.5 years' experience with EUS was undertaken and the findings at EUS correlated with the pathology of the resected specimen. Results: A total of 124 patients (86 males), with a mean age of 64.5 years, underwent EUS: 84 had adenocarcinoma and 26 squamous cell carcinoma. There were 3 failed EUS examinations, 42 patients did not have surgery for a var iety of reasons, and 10 patients had pre-operative chemoradiotherapy. In th e remaining 69 patients, correlation for T stage showed an accuracy of EUS of 80% and for N staging of 54% overall. Comparison of the initial 2 years with the final 18 months showed no change in the T staging accuracy but an improvement in the N staging accuracy from 50% to 60%. Conclusion: Once initial experience has been gained, EUS is an accurate pro cedure for T and N staging of tumours of the oesophagus and gastro-oesophag eal junction. It should be included with other imaging modalities, such as CT scanning, in the pre-operative assessment of these tumours.