Endoscopic ultrasonography-detected low-volume ascites as a predictor of inoperability for oesophagogastric cancer

Abstract

Endoscopic ultrasonography (EUS) can detect low-volume ascites (LVA) not apparent on computed tomography. The aim of this study was to assess the importance of LVA for management of patients with oesophagogastric (OG) cancer. Patients with LVA were identified from a prospective OG cancer unit database between January 2002 and January 2006. Of 1118 patients staged with OG cancer, 802 had EUS. The incidence of LVA was 8.4 per cent overall but fell to 6.5 per cent when those with metastases on computed tomography were excluded. Only patients with gastric and OG junction carcinoma had LVA. Staging laparoscopy in the 21 patients with LVA revealed that 11 (52 per cent) were inoperable. The remainder had laparotomy and complete (R0) resection was possible in only five (50 per cent). In 106 patients who had staging laparoscopy after EUS without LVA, 37 (34.9 per cent) were inoperable and 56 of the remaining 69 (81 per cent) had R0 resection. The presence of LVA on EUS is uncommon in patients with OG cancer but very important, being indicative of incurable disease in 76 per cent. This information will be helpful in counselling patients regarding management options and the low likelihood of potentially curative treatment.