TU1.10 Oesophageal/ Oesophagogastric Junction Cancer: EUS Role Revisited

Abstract

Abstract Introduction Oesophageal and Oesophago-gastric junctional (OGJ) cancer remains a challenge both from the perspective of early diagnosis, prompt staging and subsequent treatment. The prognosis of these cancers is directly related to the stage of the disease at diagnosis. CT scan followed by Endoscopic ultrasound (EUS) are investigations which help with the T and N staging. In conjunction with staging tools like PET and laparoscopy there is a resultant delay with frequent breaching of treatment targets. Reducing the number of investigations potentially avoids delays in the management pathway. Methods We conducted a retrospective audit on patients who have had oesophageal cancer resections from 2017 to 2021. We compared the accuracy of the CT scan in comparison to EUS staging preoperatively with final histopathological staging. Patients who had neo-adjuvant therapy were excluded from the final histological comparisons. Results CT is routinely performed in all patients with oesophageal cancer. All oesophageal cancers going for treatment had EUS staging. EUS staging was found most useful for Tx and T1 stages. We did not find EUS additionally useful for T2 and T3 stages. EUS is useful for T4 stages to help exclude inoperability. Conclusion Modern multi-slice CT scans provide a comparable accuracy to EUS for T2 and T3. This suggests that EUS staging can be avoided for CT stage T2 and T3 cancers of the oesophagus and GOJ. This is in keeping with current NICE guidance. EUS has a role in TX, T1 and T4 cancers and can be selectively used as per other specific indications.