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World J Gastrointest Endosc. Apr 16, 2022; 14(4): 205-214
Published online Apr 16, 2022. doi: 10.4253/wjge.v14.i4.205
Role of endoscopic ultrasound in esophageal cancer
Mark Radlinski, Vanessa M Shami
Mark Radlinski, Internal Medicine, University of Virginia, Charlottesville, VA 22901, United States
Vanessa M Shami, Digestive Health Center, University of Virginia Health System, Charlottesville, VA 22901, United States
Author contributions: Both authors have written and reviewed the manuscript in its entirety.
Conflict-of-interest statement: Mark Radlinski has no conflict of interests
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Vanessa M Shami, MD, Professor, Digestive Health Center, University of Virginia Health System, POB 800708, Charlottesville, VA 22901, United States. vms4e@hscmail.mcc.virginia.edu
Received: May 19, 2021
Peer-review started: May 19, 2021
First decision: June 17, 2021
Revised: June 25, 2021
Accepted: March 14, 2022
Article in press: March 14, 2022
Published online: April 16, 2022
Processing time: 324 Days and 9.3 Hours
Abstract

Esophageal cancer (ECA) affects 1 in 125 men and 1 in 417 for women and accounts for 2.6% of all cancer related deaths in the United States. The associated survival rate depends on the stage of the cancer at the time of diagnosis, making adequate work up and staging imperative. The 5-year survival rate for localized disease is 46.4%, regional disease is 25.6%, and distant/metastatic disease is 5.2%. Additionally, treatment is stage-dependent, making staging all that much important. For nonmetastatic transmural tumors (T3) and/or those that have locoregional lymph node involvement (N), neoadjuvant therapy is recommended. Conversely, for those who have earlier tumors, upfront surgical resection is reasonable. While positron emission tomography/computed tomography and other cross sectional imaging modalities are exceptional for detecting distant disease, they are inaccurate in staging locoregional disease. Endoscopic ultrasound (EUS) has played a key role in the locoregional (T and N) staging of newly diagnosed ECA and has an evolving role in restaging after neoadjuvant therapy. There is even data to support that the use of EUS facilitates proper triaging of patients and may ultimately save money by avoiding unnecessary or futile treatment. This manuscript will review the current role of EUS on staging and restaging of ECA.

Keywords: Esophageal Cancer; Esophageal adenocarcinoma; Esophageal squamous cell carcinoma; Staging; Endoscopic ultrasound

Core Tip: Esophageal cancer (ECA) affects 1 in 125 men and 1 in 417 for women and accounts for 2.6% of all cancer related deaths. The associated survival rate depends on the stage of the cancer when it is first diagnosed; therefore, adequate work up and staging is imperative. Additionally, treatment is stage-dependent, making staging all that much important. Endoscopic ultrasound has played a key role in the locoregional staging of newly diagnosed ECA and has an evolving role in restaging after neoadjuvant therapy. This manuscript will review the current role of endoscopic ultrasound on staging and restaging of ECA.