[Endosonography in oncology of the upper gastrointestinal tract]

Abstract

Based on our own experience and on data from the literature, we report on the indications for and efficiency of endoscopic ultrasound (EUS) in the oncology of the upper gastrointestinal tract. At the present time the following conclusions can be drawn: Intramural tumors can be clearly visualized and differentiated from extragastric conditions by EUS. Pancreatic tumors smaller than 2 cm can be delineated exactly by EUS and the sensitivity of EUS in demonstrating pancreatic tumors is 90%, a fact which is especially helpful in the early diagnosis of endocrine tumors. Since the endosonographic aspect does not allow us to separate unequivocally benign from malignant alterations, a clear distinction between inflammatory (pseudo) tumors and neoplastic pancreatic lesions based on EUS findings alone is not possible. The main indication for EUS is in regional TN-staging. The pT-stage of esophageal cancers can be determined correctly in 84% (73-92), of gastric carcinomas in 80% (69-92), of pancreatic cancers in 90% (88-92) and of the distal common bile duct and of papilla of Vater in 85% (83-89) of cases. EUS is superior to computed tomography, especially in early tumor stages. The correct EUS-staging of proximal bile duct tumors and of gallbladder cancer is far more difficult, especially when the latter is filled with stones. Local lymph node metastases are visualized by EUS in about 70-90% of cases. EUS is also valuable in evaluation of the anastomosis after operative resection of esophageal or gastric carcinoma, as well as in the follow-up of patients with gastric non-Hodgkin lymphomas during radiochemotherapy.