Role of endosonography in the surveillance of resected esophageal cancers

Abstract

Surveillance following esophagectomy for esophageal carcinoma has generally relied on conventional radiographic imaging and standard endoscopy. Studies have clearly demonstrated the superior ability of endoscopic ultrasound in the diagnosis of local endoluminal, extraluminal, and lymph node recurrence. Although early diagnosis of recurrent disease has not been established to improve survival, it may have important palliative consequences. Three abnormal endoscopic ultrasonography findings have been demonstrated: (1) free fluid surrounding the gastroesophageal anastomosis, (2) suspicious lymph nodes within the mediastinum and adjacent to the anastomosis, and (3) focal wall thickening or presence of mass adjacent to the wall gastroesophageal anastomosis. Only the latter two findings have sufficiently high positive predictive values to be independently reliable. With the emergence of endosonography guided fine-needle aspiration biopsy, it is important to confirm abnormal findings histologically. It is recommended that surveillance programs incorporate the use of endosonography at 6-month intervals after esophageal resection over a 2-year period. Patients at high risk for recurrence, those with transmural disease (T3/T4) or local regional lymph nodes (N 1 ) at the time of resection, should have EUS examinations more frequently (3 to 4 month intervals).