Esophageal dilation for endosonographic evaluation of malignant esophagealstrictures is safe and effective

OBJECTIVE: Endoscopic ultrasound (EUS) is accepted as the most accurate mod ality for T- and N-staging of esophageal cancer, but some malignant strictu res prevent passage of the echoendoscope beyond the level of the tumor. Thi s incomplete evaluation may decrease staging accuracy. Previous studies hav e yielded conflicting results regarding the safety and efficacy of esophage al dilation for EUS. METHODS: We prospectively evaluated 267 consecutive patients undergoing EUS for esophageal carcinoma staging at our institution over a 66-month period to determine the number of patients requiring dilation for EUS examination , the success of dilation, safety of dilation, and clinical importance. RESULTS: Among 267 endosonographic examinations of the esophagus, 81(30.3%) required dilation to advance the echoendoscope beyond the level of the str icture. After dilation was performed, the echoendoscope could be passed thr ough the stricture in 69 patients (85.2%), and in 63 of 67 of the patients dilated to greater than or equal to 14 mm (94.0%). No complications have oc curred secondary to the dilations performed to permit completion of the end osonographic examination. Tumor staging by EUS after dilation was T2 (14.8% ), T3 (56.8%), and T4 (21.0%), nodal staging N0 (14.6%) and N1 (75.3%); and MI (9.9%). CONCLUSIONS: We conclude that incremental, stepwise dilation of malignant s trictures to 14 mm is safe and effective in permitting echoendoscope passag e beyond the stenosis. The presence of a malignant stricture does not seem to diminish the utility of EUS staging of esophageal cancer. (Am J Gastroen terol 2000;95:2813-2815. (C) 2000 by Am. Coll. of Gastroenterology).