Dilation of malignant esophageal strictures followed by endosonography (EUS) is safe and clinically important

Douglas Orrick Faigel, G. G. Ginsberg, S. L. Kadish, D. Smith, M. L. Kochman

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Abstract

It has been suggested that dilation of esophageal strictures prior to EUS has a high morbidity and a low clinical yield and should not be routinely performed. We report our prospective experience with esophageal dilation for EUS staging. 93 patients with esophageal malignancies underwent EUS (Olympus GF-UM20). 29 (31%) had malignant strictures (Adeno-19, Squamous-8, Other-2) precluding safe passage of the EUS scope (estimated lumen diameter=8.7 ± 1.9 mm, mean ± SD). Esophageal dilation was performed with wire guided Savary dilators (n=27) or TTS balloons (n=2) to a median 15 mm (range 11-16) using a median 4 dilators (range 1-6). Following dilation, the EUS scope was able to be passed beyond the stricture in 26 patients (90%), and in all patients dilated to at least 14 mm. There were no procedure-related complications. EUS stages were: T2-8 (28%), T3-11 (38%), T4-6 (21%), Tx-4 (14%), N1-23 (79%), M1-5 (celiac nodes)(17%). 14 patients had complete surgical staging; one had partial operative staging. There was only one T2 lesion (7%); the remainder were T3-11 (79%) and T4-2 (14%). EUS understaged 5 Surgical-T3 as T2, and one surgical-T4 as T3 (accuracy=57%). There were no EUS overstages. 12 surgical patients were N1 and 5 M1. EUS N-stage accuracy was 80%, however, when 3 patients who received preoperative chemo/XRT were excluded, N stage accuracy was 92%. Of 5 surgical-M1 patients, 2 had celiac nodes correctly identified on EUS, and 3 had distant metastases not seen on EUS. Conclusions: 1. Esophageal dilation prior to EUS is safe. 2. Approximately 1/3 of patients with esophageal cancer require dilation prior to EUS. 3. Dilation to at least 14 mm is needed to safely pass the GF-UM20. 4. The majority of patients requiring dilation have high-stage lesions, and EUS tends to under T-stage. 5. The primary utility of EUS in these patients is in detecting T4 tumors and regional (N1) and celiac (M1) adenopathy which may alter treatment to preoperative neoadjuvant therapy or non-operative palliation.

Original languageEnglish (US)
Pages (from-to)418
Number of pages1
JournalGastrointestinal Endoscopy
Volume43
Issue number4
StatePublished - 1996
Externally publishedYes

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Esophageal Stenosis
Endosonography
Dilatation
Abdomen
Pathologic Constriction
Neoadjuvant Therapy
Esophageal Neoplasms
Neoplasms
Neoplasm Metastasis
Morbidity

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Dilation of malignant esophageal strictures followed by endosonography (EUS) is safe and clinically important. / Faigel, Douglas Orrick; Ginsberg, G. G.; Kadish, S. L.; Smith, D.; Kochman, M. L.

In: Gastrointestinal Endoscopy, Vol. 43, No. 4, 1996, p. 418.

Research output: Contribution to journalArticle

Faigel, Douglas Orrick ; Ginsberg, G. G. ; Kadish, S. L. ; Smith, D. ; Kochman, M. L. / Dilation of malignant esophageal strictures followed by endosonography (EUS) is safe and clinically important. In: Gastrointestinal Endoscopy. 1996 ; Vol. 43, No. 4. pp. 418.
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title = "Dilation of malignant esophageal strictures followed by endosonography (EUS) is safe and clinically important",
abstract = "It has been suggested that dilation of esophageal strictures prior to EUS has a high morbidity and a low clinical yield and should not be routinely performed. We report our prospective experience with esophageal dilation for EUS staging. 93 patients with esophageal malignancies underwent EUS (Olympus GF-UM20). 29 (31{\%}) had malignant strictures (Adeno-19, Squamous-8, Other-2) precluding safe passage of the EUS scope (estimated lumen diameter=8.7 ± 1.9 mm, mean ± SD). Esophageal dilation was performed with wire guided Savary dilators (n=27) or TTS balloons (n=2) to a median 15 mm (range 11-16) using a median 4 dilators (range 1-6). Following dilation, the EUS scope was able to be passed beyond the stricture in 26 patients (90{\%}), and in all patients dilated to at least 14 mm. There were no procedure-related complications. EUS stages were: T2-8 (28{\%}), T3-11 (38{\%}), T4-6 (21{\%}), Tx-4 (14{\%}), N1-23 (79{\%}), M1-5 (celiac nodes)(17{\%}). 14 patients had complete surgical staging; one had partial operative staging. There was only one T2 lesion (7{\%}); the remainder were T3-11 (79{\%}) and T4-2 (14{\%}). EUS understaged 5 Surgical-T3 as T2, and one surgical-T4 as T3 (accuracy=57{\%}). There were no EUS overstages. 12 surgical patients were N1 and 5 M1. EUS N-stage accuracy was 80{\%}, however, when 3 patients who received preoperative chemo/XRT were excluded, N stage accuracy was 92{\%}. Of 5 surgical-M1 patients, 2 had celiac nodes correctly identified on EUS, and 3 had distant metastases not seen on EUS. Conclusions: 1. Esophageal dilation prior to EUS is safe. 2. Approximately 1/3 of patients with esophageal cancer require dilation prior to EUS. 3. Dilation to at least 14 mm is needed to safely pass the GF-UM20. 4. The majority of patients requiring dilation have high-stage lesions, and EUS tends to under T-stage. 5. The primary utility of EUS in these patients is in detecting T4 tumors and regional (N1) and celiac (M1) adenopathy which may alter treatment to preoperative neoadjuvant therapy or non-operative palliation.",
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AU - Ginsberg, G. G.

AU - Kadish, S. L.

AU - Smith, D.

AU - Kochman, M. L.

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N2 - It has been suggested that dilation of esophageal strictures prior to EUS has a high morbidity and a low clinical yield and should not be routinely performed. We report our prospective experience with esophageal dilation for EUS staging. 93 patients with esophageal malignancies underwent EUS (Olympus GF-UM20). 29 (31%) had malignant strictures (Adeno-19, Squamous-8, Other-2) precluding safe passage of the EUS scope (estimated lumen diameter=8.7 ± 1.9 mm, mean ± SD). Esophageal dilation was performed with wire guided Savary dilators (n=27) or TTS balloons (n=2) to a median 15 mm (range 11-16) using a median 4 dilators (range 1-6). Following dilation, the EUS scope was able to be passed beyond the stricture in 26 patients (90%), and in all patients dilated to at least 14 mm. There were no procedure-related complications. EUS stages were: T2-8 (28%), T3-11 (38%), T4-6 (21%), Tx-4 (14%), N1-23 (79%), M1-5 (celiac nodes)(17%). 14 patients had complete surgical staging; one had partial operative staging. There was only one T2 lesion (7%); the remainder were T3-11 (79%) and T4-2 (14%). EUS understaged 5 Surgical-T3 as T2, and one surgical-T4 as T3 (accuracy=57%). There were no EUS overstages. 12 surgical patients were N1 and 5 M1. EUS N-stage accuracy was 80%, however, when 3 patients who received preoperative chemo/XRT were excluded, N stage accuracy was 92%. Of 5 surgical-M1 patients, 2 had celiac nodes correctly identified on EUS, and 3 had distant metastases not seen on EUS. Conclusions: 1. Esophageal dilation prior to EUS is safe. 2. Approximately 1/3 of patients with esophageal cancer require dilation prior to EUS. 3. Dilation to at least 14 mm is needed to safely pass the GF-UM20. 4. The majority of patients requiring dilation have high-stage lesions, and EUS tends to under T-stage. 5. The primary utility of EUS in these patients is in detecting T4 tumors and regional (N1) and celiac (M1) adenopathy which may alter treatment to preoperative neoadjuvant therapy or non-operative palliation.

AB - It has been suggested that dilation of esophageal strictures prior to EUS has a high morbidity and a low clinical yield and should not be routinely performed. We report our prospective experience with esophageal dilation for EUS staging. 93 patients with esophageal malignancies underwent EUS (Olympus GF-UM20). 29 (31%) had malignant strictures (Adeno-19, Squamous-8, Other-2) precluding safe passage of the EUS scope (estimated lumen diameter=8.7 ± 1.9 mm, mean ± SD). Esophageal dilation was performed with wire guided Savary dilators (n=27) or TTS balloons (n=2) to a median 15 mm (range 11-16) using a median 4 dilators (range 1-6). Following dilation, the EUS scope was able to be passed beyond the stricture in 26 patients (90%), and in all patients dilated to at least 14 mm. There were no procedure-related complications. EUS stages were: T2-8 (28%), T3-11 (38%), T4-6 (21%), Tx-4 (14%), N1-23 (79%), M1-5 (celiac nodes)(17%). 14 patients had complete surgical staging; one had partial operative staging. There was only one T2 lesion (7%); the remainder were T3-11 (79%) and T4-2 (14%). EUS understaged 5 Surgical-T3 as T2, and one surgical-T4 as T3 (accuracy=57%). There were no EUS overstages. 12 surgical patients were N1 and 5 M1. EUS N-stage accuracy was 80%, however, when 3 patients who received preoperative chemo/XRT were excluded, N stage accuracy was 92%. Of 5 surgical-M1 patients, 2 had celiac nodes correctly identified on EUS, and 3 had distant metastases not seen on EUS. Conclusions: 1. Esophageal dilation prior to EUS is safe. 2. Approximately 1/3 of patients with esophageal cancer require dilation prior to EUS. 3. Dilation to at least 14 mm is needed to safely pass the GF-UM20. 4. The majority of patients requiring dilation have high-stage lesions, and EUS tends to under T-stage. 5. The primary utility of EUS in these patients is in detecting T4 tumors and regional (N1) and celiac (M1) adenopathy which may alter treatment to preoperative neoadjuvant therapy or non-operative palliation.

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