Help
Subscribe


GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy

 18 February 2018

Advanced search
GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy Profile of Roy Pounder

Home

News  
Journals
Review Articles
Slide Atlas
Video Clips
Online Books
Advanced Digestive Endoscopy
Classical Cases
Conference Diary
PubMed
International GH Links
USA GH Links
National GH Links
National GI Societies
Other Useful Links




Emails on Gastroenterology and Hepatology
the National AIDS Treatment Advocacy Project
Visit the gastroenterology section of the EUMS

News

Endoscopy is superior to CT for tumor staging in Barrett's

In suspected early cancer in Barrett's, endoscopic ultrasound is superior to computed tomography for tumor node staging, finds October's American Journal of Gastroenterology.

News image

fiogf49gjkf04

Computed tomography(CT) and endoscopic ultrasound are part of the regular staging protocol in esophageal cancer.

The value of the 2 methods was assessed in patients with early cancer in Barrett's esophagus.

Dr Oliver Pech and colleagues from Germany evaluated 100 consecutive patients with a median age of 64 years.

The investigators assigned patients with suspected early cancer in Barrett's to a standardized staging program with upper gastrointestinal endoscopy.

Endoscopic ultrasound, computed tomography of the chest and upper abdomen, and abdominal ultrasonography were performed.

The investigators summarized the results in accordance with the tumor node metastases classification.

Sensitivity of endoscopic ultrasound for N staging was 75%
American Journal of Gastroenterology

On the basis of the lymph node findings on computed tomography and/or endoscopic ultrasound, the patients were assigned to 3 categories.

Patients in category 1 had no suspicious lymph nodes.

The investigators assigned patients with paraesophageal lymph nodes less than 1 cm in size at the tumor level to category 2.

These patients also had lymph nodes more than 1 cm in size not at the tumor level in the mediastinum or celiac trunk.

In category 3, the team included patients with paraesophageal lymph nodes more than 1 cm in size at the tumor level.

The endoscopic ultrasound and computed tomography findings were checked every 6 months in patients who underwent endoscopic treatment.

The investigative team scheduled surgical resection in operable patients if staging showed a T category higher than T1.

The team also undertook surgical resection in patients where the lymph node staging was assessed according to the classification of category 3.

Patients with suspected submucosal infiltration underwent diagnostic endoscopic resection.

If submucosal involvement was confirmed, the patients were referred for surgery.

The investigators reported that the median follow-up period was 25 months.

The T category diagnosed with computed tomography was T1 or less in all patients.

On endoscopic ultrasound, the T category was classified as T1 in 92% of cases, and as more than T1 in 8%.

The investigators detected enlarged lymph nodes in 45% of the patients.

The investigative team diagnosed significantly more category 2 lymph nodes with endoscopic ultrasound than computed tomography.

The team identified lymph nodes at the level with the highest suspicion, in category 3, using computed tomography in only 3 of 9 cases.

Sensitivity of computed tomography for N staging was 38% compared with 75% for endoscopic ultrasound.

The investigators found no extranodal metastases on computed tomography.

Dr Pech's team concludes, “In suspected early cancer in Barrett's esophagus, endoscopic ultrasound is superior to computed tomography for T staging and N staging.”

“Computed tomography had no influence on the tumor node metastases classification in any of these patients.”

“It may therefore be possible to dispense with this method as a staging procedure in patients with cancer in Barrett's esophagus.”

“By contrast, endoscopic ultrasound is required in order to differentiate between patients with cancer in Barrett's esophagus in whom endoscopic therapy is suitable and those in whom surgical treatment is required.”

Am J Gastroenterol 2006: 101(10): 2223
13 October 2006

Go to top of page Email this page Email this page to a colleague

 16 February 2018 
Undetected celiac in the elderly
 16 February 2018 
Inflammatory bowel diseases are global diseases
 16 February 2018 
Fructans induce non-celiac gluten sensitivity
 15 February 2018 
Oral direct-acting antiviral treatment for Hep C virus genotype 1
 15 February 2018 
NSAIDS and GI damage
 15 February 2018 
Primary vs secondary surgery for the presence of lymph node metastasis
 14 February 2018 
Management of hemorrhoids in the USA
 14 February 2018 
Predicting adenoma detection rate
 14 February 2018 
Normal bowel frequency characterization in the USA 
 13 February 2018 
Prebiotics improve endothelial dysfunction
 13 February 2018 
Personalising treatment options for IBS
 13 February 2018 
Diagnostic criteria for a Rome IV functional gastrointestinal disorders
 12 February 2018 
Visceral hypersensitivity and functional GI disorders
 12 February 2018 
Depression and aggressive IBD
 12 February 2018 
Variability in interpretation of endoscopic findings impacts patient management
 09 February 2018 
Treatment of choice for anastomotic stricture in IBD
 09 February 2018 
PRO measurement information system 
 09 February 2018 
Overall disease severity indices for IBD
 08 February 2018 
Prediction of endoscopically active disease

 08 February 2018 
Steroid-refractory acute severe ulcerative colitis
 08 February 2018 
Decision aid used by IBD patients
 07 February 2018 
Ursodeoxycholic acid combined with bezafibrate for itching
 07 February 2018 
Change in microbiome in gastritis vs gastric carcinoma
 07 February 2018 
Colorectal cancer and primary sclerosing cholangitis-IBD
 06 February 2018 
Risk of death after liver transplantation
 06 February 2018 
Crohn’s disease vs refractory pouchitis
 06 February 2018 
Support for functional dyspepsia symptom diary
 05 February 2018 
Helicobacter spp influence on GI tract 
 05 February 2018 
No link found between severe reflux and all-cause mortality 
 05 February 2018 
Psychological distress in PPI non-responders
 02 February 2018 
Assessing psychosexual impact of IBD
 02 February 2018 
Decrease in overall mortality with cholera vaccination
 02 February 2018 
Diagnostic performance of fecal immunochemical tests
 01 February 2018 
Screening frequency with family histories of colorectal cancer
 01 February 2018 
IBD and sport participation
 01 February 2018 
Life with a stoma 
 31 January 2018 
Aprepitant and gastroparesis 
 31 January 2018 
Anesthesia risk in colonoscopy
 31 January 2018 
GED-0301 for Crohn's Disease
 30 January 2018 
Intestinal dysbiosis and allergic diseases in infants
 30 January 2018 
Fructans and IBS symptoms in children
 29 January 2018 
Dosing calculator for therapy optimization in IBD
 29 January 2018 
Glecaprevir–pibrentasvir for in HCV
 29 January 2018 
Food allergen injections in eosinophilic esophagitis
 29 January 2018 
Reliability of the IBD index
 26 January 2018 
Tofacitinib vs biological therapies for ulcerative colitis
 26 January 2018 
Optimizing selection of biologics in IBD
 26 January 2018 
Nutritional risk and laparoscopic-assisted gastrectomy outcomes
 25 January 2018 
Patient-reported outcome measure for functional dyspepsia
 25 January 2018 
Predicting intra-abdominal infections after colorectal surgery
 25 January 2018 
Predictors of gastric cancer risk
 24 January 2018 
Risk factors underlying previously undiagnosed cirrhosis
 24 January 2018 
Ethnicity influences phenotype in IBD
 24 January 2018 
Bariatric surgery vs medical obesity treatment
 23 January 2018 
Atrophic gastritis after H. pylori eradication
 23 January 2018 
Ectopic pregnancy in women with IBD
 23 January 2018 
Celiac disease in IBS in the USA
 22 January 2018 
Improving symptoms in GERD
 22 January 2018 
Costs of biologic therapies for IBD in the USA
 22 January 2018 
Western vs Asian guidelines for colon cancer management

Blackwell Publishing


GastroHep.com is a Blackwell Publishing registered trademark
© 2018 Wiley-Blackwell and GastroHep.com and contributors
Privacy Statement
Disclaimer
About Us