Abstract
Background and AimEndoscopic biopsy is standard for the diagnosis of esophageal malignancy. However, few cases present with smooth stricture with repetitive negative biopsy results. We aimed to use linear endoscopic ultrasound (EUS) and fine‐needle aspiration (FNA) in the diagnosis of biopsy‐negative suspected malignant esophageal strictures.MethodsWe retrospectively analyzed the data from August 2017 to December 2018 of biopsy‐negative esophageal strictures. All adult patients with twice‐negative biopsies and with smooth overlying esophageal mucosa on endoscopy were included. Clinical, epidemiological, endoscopic, imaging, and EUS findings were noted and analyzed.ResultsEighteen patients underwent EUS for suspicion of malignant esophageal stricture. Seven were excluded as they were submucosal tumors. Eleven patients showed the presence of malignancy on EUS FNA samples. Nine were males. Computed tomography showed esophageal wall thickening in eight (16–38 mm) and esophageal mass in three patients. EUS showed loss of a normal five‐layered wall structure of the esophagus in all patients. Fine‐needle aspiration cytology demonstrated squamous cell carcinoma (n = 4), adenocarcinoma (n = 4), poorly differentiated carcinoma (n = 2), and neuroendocrine carcinoma (n = 1). There were no complications.ConclusionEUS with FNA is effective and safe for the diagnosis of biopsy‐negative malignant esophageal strictures.
Highlights
Endoscopic ultrasound (EUS) is a proven modality for the staging of esophageal cancer.[1]
Our study shows the utility of linear endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) for the diagnosis of esophageal malignancy in patients with biopsy-negative esophageal strictures
The earliest report in biopsy-negative malignant stricture is of radial EUS, and visual appearance was taken as the diagnostic criterion for malignancy, which was later confirmed on postoperative histopathological specimens.[3]
Summary
Endoscopic ultrasound (EUS) is a proven modality for the staging of esophageal cancer.[1] its role in diagnosis is not well studied. Endoscopic biopsy is standard for the diagnosis of esophageal malignancy. Few cases present with smooth stricture with repetitive negative biopsy results. We aimed to use linear endoscopic ultrasound (EUS) and fine-needle aspiration (FNA) in the diagnosis of biopsy-negative suspected malignant esophageal strictures. All adult patients with twice-negative biopsies and with smooth overlying esophageal mucosa on endoscopy were included. Results: Eighteen patients underwent EUS for suspicion of malignant esophageal stricture. Eleven patients showed the presence of malignancy on EUS FNA samples. Conclusion: EUS with FNA is effective and safe for the diagnosis of biopsy-negative malignant esophageal strictures
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