USE OF ENDOSCOPIC ULTRASOUND IN THE SURGICAL MANAGEMENT OF EARLY ADENOCARCINOMA OF GASTRIC CARDIA: A CASE STUDY

Introduction: There's a increase of neoplasia of the gastro-esophageal transition. In parallel, there was an evolution in the diagnosis with the use of new methods and precise indication of surgical and adjuvant therapy. According to the Protocols of the National Comprehensive Cancer Network and the European Society for Medical Oncology the indication of primary surgery in this pathology is for T1b tumors, remaining mucosectomy for T1a and Tis tumors and neoadjuvant therapy for tumors T2-4 . When staging, to evaluate the depth of the tumor (T) and the involvement of lymph nodes (N), endoscopic ultrasound (EUS) is the most sensitive and specific method. Objectives: To report the use of EUS for primary surgical indication in gastric cardia neoplasia. The method provided adequate management. Methods: Presentation of a case with surgical intervention of a gastric cardia tumor after EUS and review of the literature. Results: Female patient, 46 years old, complaining of pyrosis and epigastric pain. Submitted to upper digestive endoscopy that showed in the Z line a erosion and in the gastric cardia a lesion of metaplastic appearance with edema in the region. Biopsy confirms the diagnosis of adenocarcinoma. For staging a computed tomography was performed, without alterations. The EUS showed a vegetative lesion with infiltrative borders of the mucosa and submucosa, below the Z line, with about 4,7mm (T1B), defining the Videolaparoscopic esophagectomy with lymphadenectomy as primary oncological treatment. The pathology demonstrated moderately differentiated adenocarcinoma with invasion of the mucosal muscle. Conclusion: With the use of the EUS we obtain in relation to the other imaging exams higher specificity and sensitivity (T with sensitivity of 81-90% and specificity of 99%. For N, sensitivity of 96.7% and specificity of 95,5% ). The accuracy of the EUS indicating invasion of the mucosa and submucosa, staging in T1b, defines the conduct taken according to the current guidelines. In the case reported above, the EUS enabled adequate patient management, avoiding residual tumor or only neoadjuvant therapy. The anatomopathological examination of the surgical specimen was pT1a, revealing that the imaging method is reliable in the management of cardia tumors. Therefore, despite the limiting factor of the accuracy of the EUS in early neoplasia being superstaging because the edema or inflammation, is the best diagnostic tool of precision and leads to better prognosis.

Publication History

Article published online:
23 October 2019