7230 Impassable antropyloric stricture is predictive of advanced tumor stage.

Abstract

Presently endoscopic ultrasound (EUS) is the most accurate modality for T and N staging of gastric carcinoma. Of patients with tumors in the antropyloric region, a proportion presents with high-grade strictures that preclude passage of the echoendoscope. It is our impression that these tumors are generally of the advanced stages. However, to our knowledge, this subject has not been formally studied. AIM: To determine the tumor stage of patients presenting with impassable malignant strictures of the antropylorus. METHODS: Preoperative EUS was performed on 30 consecutive patients with gastric carcinoma, using a radial echoendoscope (GFUM200, Olympus Co. Ltd., Singapore). The results of preoperative staging were prospectively compared with pathologic stage of the gastrectomy specimen when available, the surgical specimen or metastatic disease at the time of surgery. RESULTS: Of the 30 gastric carcinoma, 18 (60%) were located in the antropyloric region, 8 in the corpus and the rest in the cardia. Of the antropyloric tumors, 7 (39%) presented with stenoses that precluded passage of the echoendoscope. Staging of the proximal aspect of the tumor was obtained in all of these patients, however, the TNM staging accuracy for such incomplete staging was only 29% (2 of 7). Correct T assessment was obtained in only 4 such patients (57%). In contrast, the T staging accuracy in those patients with antropyloric carcinoma presenting with less severe stricture that allowed passage of the echoendoscope was 82%. By histologic examination of the surgical specimen, 5 of the 7 patients with impassable antropyloric strictures had stage IV disease while 2 had stage III disease. In contrast, the proportions of patients with passable tumors that had stage I, II, III and IV diseases were 3, 3, 2 and 3 respectively (p