Does routine staging with endoscopic ultrasound in patients with obstructing esophageal cancer really impacts in treatment decisions?

Aims Endoscopic ultrasound (EUS) is essential for the preoperative staging of esophagogastric neoplasms, as it facilitates the selection of the most appropriate treatment for each patient. However, stenosing lesions often prevent complete assessment and are associated with advanced staging, which limits the effectiveness of EUS. Despite these limitations, EUS procedures continue to be requested without discriminating whether the lesions are stenosing in the initial gastroscopy. The objective was to determine the EUS staging of stenosing esophagogastric lesions and compare it with that of non-stenosing lesions to evaluate its contribution to diagnosis.

Methods This observational, retrospective study analyzed cases of EUS for staging esophagogastric lesions at a tertiary care center from June 2022 to June 2024. Demographic data, endoscopic tumor characteristics, EUS staging, and type of treatment were recorded. The final staging of patients who underwent surgery was also documented. Locally advanced disease was defined as at least T3.

Results A total of 95 out of 100 patients with esophagogastric tumors were included. Of these, 26 (27.4%) presented with esophageal lesions, 51 (53.7%) with gastric lesions, and 18 (18.9%) with gastroesophageal junction lesions. The most frequent local staging based on EUS was T3, observed in 38 patients (43.6%). In the initial gastroscopy, 13 patients (13.68%) presented an obstructive mass, of which 12 (92.3%) were locally advanced lesions (p<0.0001). In contrast, for non-stenosing lesions, the distribution of local staging was T1 in 20 patients (29.8%), T2 in 23 (34.3%), T3 in 21 (31.3%), and T4 in 2 (2.9%). The nodal staging distribution in stenosing lesions was Nx (1), N1 (7), N2 (4), and N3 (1), with a trend toward an association between stenosis and N staging grade (p=0.052). A total of 49 (51.6%) patients who underwent EUS had resection surgery, with the most common final staging being T1N0. Notably, 7 (54%) of the stenosing lesions observed in gastroscopy proceeded to resection surgery.

Conclusions The presence of a stenosing lesion in gastroscopy is associated with advanced disease stages, suggesting that EUS may be unnecessary for these patients

Publication History

Article published online:
27 March 2025