Journal
BEST PRACTICE & RESEARCH CLINICAL GASTROENTEROLOGY
Volume 23, Issue 5, Pages 649-661Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.bpg.2009.05.002
Keywords
endoscopic ultrasonography (EUS); endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA); oesophageal carcinoma; gastric carcinoma; staging of upper gastrointestinal malignancies; lymph node metastases
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Numerous studies conducted over the last 25 years provide evidence on the high diagnostic accuracy and important role of endoscopic ultrasonography (EUS) in staging oesophageal and gastric carcinoma. This extensive research was recently subjected to meta-analyses, condensing our knowledge on EUS performance and facilitating its comparison with competing methods. It is, however, important to realise that the management of oesophageal and gastric carcinoma is evolving and so are staging algorithms, setting new challenges for EUS and re-defining its position. Restaging after neoadjuvant treatment and precise assessment of early carcinoma before endoscopic treatment are areas of growing interest, but the role of EUS in these settings is rather limited. Rapidly developing cross-sectional imaging has the potential to challenge the position of EUS as the most accurate method in loco-regional staging. On the other hand, EUS guided fine-needle aspiration offers the unique opportunity to obtain cytological confirmation of lymph node metastases, with future potential for molecular staging. (C) 2009 Elsevier Ltd. All rights reserved.
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