Dilation of malignant esophageal strictures prior to endoscopic ultrasound (EUS) is controversial because of the risk of perforation. EUS has been shown to be the most accurate modality for local staging of esophageal cancer. We report our prospective series for esophageal dilation of malignant strictures to allow EUS staging. Methods: 162 consecutive patients with esophageal cancer referred for endoscopic ultrasound (Olympus GF-UM20) were reviewed. Results: 43 patients (27%) had malignant esophageal strictures which prevented EUS scope passage (27 adenocarcinoma, 14 squamous cell carcinoma, 2 other). Mean estimated lumen diameter was 9 mm (range 3-12 mm). Esophageal dilation was performed with either wire guided Savary dilators (38), TTS balloons (2) or both (1). In 2 patients complete luminal obstruction prevented any attempt at dilation. Mean lumen diameter after dilation was 14.7 mm (range 12-16 mm), requiring a mean of 3.75 Savary dilators (range 1-6). When dilation was performed, the EUS scope could be passed in 38 patients (93%), and in 36 of 37 patients dilated to at least 14 mm (97%). In 2/3 patient dilated to only 12 mm the EUS scope could not be passed. EUS stages were T2-9 (22%), T3-23 (56%), and T4-7 (17%), Tx-2(5%), N1-34(83%), and M1-5 [celiac nodes](12%). Excluding those who received preoperative chemoradiation, EUS accuracy was 70% for T-stage and 84% for N -stage in patients who received complete surgical staging. All EUS T-stage errors were due to understaging. Conclusions: 1. Dilation for malignant esophageal stricture prior to EUS is safe. 2. 27% of patients with esophageal cancer require dilation prior to EUS 3. Dilation to 14 mm will usually (93%) allow passage of the GF-UM20 without perforation. 4. Most lesions requiring dilation are advanced stage lesions. 5. EUS remains accurate in staging esophageal cancer after dilation of malignant strictures, but may under T-stage. 6. We feel that the primary utility of EUS in patients with obstruction is in detecting T4 tumors and regional (N1) and celiac (M1) adenopathy which may alter treatment to preoperative neo-adjuvant therapy or non-operative palliation.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging