Diagnostic role of endoscopic ultrasound in selecting patients with early barrett neoplasia for endoscopic therapy

Abstract

Introduction Correct staging is essential in selecting patients with early oesophageal neoplasia for endoscopic therapy. We prospectively investigated the diagnostic value of endoscopic ultrasound (EUS) in predicting submucosal infi ltration in early Barrett neoplasia. Methods Patients with histologically proven high grade dysplasia or intramucosal cancer who were referred for potential endoscopic treatment were included in this prospective study. All patients underwent EUS staging with radial echoendoscopic ultrasound probes (7.5 MHz). A (15 MHz) radial miniprobe was used to assess focal lesions in higher defi nition. Results 40 patients (31 men) were included. Thereof, 14 underwent oesophagectomy, 24 had endoscopic mucosal resection using the Duette Multiband device, 2 had both procedures. Final pathological results revealed 15 submucosa infi ltrating cancers and 25 neoplastic lesions limited to the mucosa. One submucosal infi ltration was missed by EUS. 5 intramucosal cancers were overstaged; 3 of these were within a stricture, one in an ulcer. For detecting submucosal invasion, EUS had a sensitivity of 93.3% (95%CI: 76.1 to 98.8%), a specifi city of 84% (73.6 to 87.3%), a negative predictive value of 95.5% (83.7 to 99.2%), and a positive predictive value of 77.8% (63.4 to 82.3%). Conclusion Stricturing and ulceration may result in EUS overstaging of early oesophageal neoplasia, but this would render endoscopic therapy diffi cult also. Knowing these limitations EUS is useful in assessing suitability for endoscopic therapy.