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Surgical Endoscopy

Published in:

01-05-2010

High-resolution endoscopy and endoscopic ultrasound for evaluation of early neoplasia in Barrett’s esophagus

Authors: T. Thomas, D. Gilbert, P. V. Kaye, I. Penman, G. P. Aithal, Krish Ragunath

Published in: Surgical Endoscopy | Issue 5/2010

Abstract

Background

Endoscopic ultrasound (EUS) is useful for detecting depth of invasion and nodal involvement in patients with early Barrett’s neoplasia (EBN), precluding endoscopic management. This study aimed to determine whether the lesion morphology of the EBN shown on high-resolution endoscopy predicts EUS and histologic tumor stage.

Methods

Retrospective series from two tertiary referral centers were studied. Patients with EBN referred for EUS evaluation before treatment were identified, and data were collected from endoscopies, a database, and case notes. All patients had high-resolution endoscopy followed by radial EUS.

Results

This study included 50 patients (22 men) with a median age of 69 years (interquartile range, 60–79 years). Visible lesions in the Barrett’s segment were described as Paris types 0–1 (n = 9), 0–IIb (n = 12), 0–IIa (n = 12), 0–IIa + IIc (n = 6), and 0–IIc (n = 5). Of the 50 patients, 46 (92%) had either EMR (n = 17), esophagectomy (n = 23), or both (n = 6). All 12 patients (100%) with Paris 0–IIb lesions had T0/T1 m staging on EUS confirmed with resection histology. The sensitivity for EUS T-staging for Paris classification was 71.4% for type 0–I, 100% for type 0–IIb, 83% for type 0–IIa, 66.7% for type 0–IIa + IIc, and 66.7% for type IIc. Overall, 8 (17%) of the 46 patients were understaged and 2 (4%) were overstaged. For detecting submucosal invasion, EUS had a sensitivity of 66%, a specificity of 93%, a negative predictive value of 85%, and a diagnostic accuracy of 84.4%.

Conclusion

Submucosal invasion is detected by EUS for 26% of patients with EBN. The value of EUS staging before resection for type 0–IIb early Barrett’s cancer (flat lesions) is limited because 100% of these lesions are limited to the mucosa. For the management algorithm in this selected cohort, the use of EUS should be reconsidered.

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Title: High-resolution endoscopy and endoscopic ultrasound for evaluation of early neoplasia in Barrett’s esophagus
Authors: T. Thomas
D. Gilbert
P. V. Kaye
I. Penman
G. P. Aithal
Krish Ragunath
Publication date: 01-05-2010
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 5/2010
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-009-0737-3

At a glance: The STEP trials

Springer Medicine

High-resolution endoscopy and endoscopic ultrasound for evaluation of early neoplasia in Barrett’s esophagus

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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