Utility of EUS following endoscopic polypectomy of high-risk rectosigmoid lesions.
Endosc Ultrasound
; 4(2): 137-44, 2015.
Article
in En
| MEDLINE
| ID: mdl-26020049
ABSTRACT
BACKGROUND:
The utility of endoscopic ultrasound (EUS) compared with standard white light endoscopy (WLE) following recent polypectomy of high-risk colorectal polyps is unknown.OBJECTIVE:
To assess the incremental yield of EUS after endoscopic polypectomy of a high-risk rectal lesion.DESIGN:
Retrospective cohort.SETTING:
Tertiary referral center. MATERIALS ANDMETHODS:
Patients referred for EUS following attempted endoscopic resection of a high-risk rectal neoplasm, defined as a tubulovillous adenoma, tubular adenoma with high-grade dysplasia, carcinoid, carcinoma in-situ or adenocarcinoma (CA).INTERVENTIONS:
Sigmoidoscopy ± mucosal biopsy and EUS ± fine-needle aspiration (FNA) to evaluate for (1) Residual polyp/tumor in the rectal wall or (2) peritumoral adenopathy. MAINOUTCOME:
Sensitivity and specificity for detection of residual neoplasia for WLE ± biopsy (WLE/BX) and EUS ± FNA for cancer (CA group) or benign disease (non-CA group). The incremental yield of EUS defined as (1) Residual intramural neoplasia not present on WLE ± BX and; (2) abnormal peritumoral adenopathy.RESULTS:
A total of 70 patients (mean age 64 ± 11 years, 61% male) with a final diagnosis of CA (n = 38) and non-CA (n = 32) were identified. There was no difference between the sensitivity and specificity of WLE alone (65% and 84%), WLE with biopsy (71% and 95%), and EUS (59% and 84%), for the detection of residual neoplasia (P > 0.05 for all). EUS identified 3 masses missed by WLE, all in the CA group. A malignant (n = 2) or benign (n = 3) node was identified in 5 (13%) CA patients; EUS-FNA in two showed residual malignancy in one and a reactive lymph node (LN) in one. No LNs were identified in the non-CA patients.LIMITATIONS:
Retrospective design, incomplete follow-up in some patients.CONCLUSION:
Following endoscopic polypectomy of high-risk rectal neoplasia, the incremental yield of EUS compared with WLE/BX for evaluation of residual disease appears limited, especially in patients with benign disease.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Type of study:
Etiology_studies
/
Risk_factors_studies
Language:
En
Journal:
Endosc Ultrasound
Year:
2015
Document type:
Article
Affiliation country:
United States
Publication country:
CHINA
/
CN
/
REPUBLIC OF CHINA