Supplement Abstracts Submitted for the 70th Annual Scientific Meeting of the American College of Gastroenterology: ESOPHAGUS
Purpose: To assess the perception of gastroenterologists who perform EUS-FNA for esophageal cancer staging and the impact of nodal involvement on therapeutic decisions.
Methods: A 15 question survey was distributed via email to gastroenterologists who perform EUS. This survey included questions related to clinical practice, referral patterns and communication with surgeons. Clinical vignettes were used to assess if EUS-FNA of lymph nodes changed therapeutic decisions made by thoracic surgeons.
Results: 77 gastroenterologists responded to the survey (31%). 68% personally perform more than 20 staging EUS procedures per year for esophageal cancer. Nearly 80% stated their institution used EUS-FNA for esophageal cancer staging in more than 60% of cases. All respondents felt it was important to directly communicate with a thoracic surgeon. 43% felt this communication should occur after the procedure, while another 41% believe communication both before and after the procedure is ideal. Over 95% felt EUS with or without FNA was the most accurate T- and N-staging test. Over 75% thought a pre-EUS PET scan is useful, particularly in identifying areas for FNA. Less than 25% of endoscopic ultrasonographers surveyed will always dilate a stricture to complete a EUS staging procedure, where as 45% will consider performing dilation on a case by case basis. All respondents consider FNA of an abnormal appearing lymph node, although only 55% will perform FNA in all such cases. If EUS-FNA found either a positive celiac or gastrohepatic ligament lymph node in a patient with a proximal esophageal cancer, the majority of respondents (92% and 65% respectively) felt this represents metastatic disease that precludes esophagectomy. 56%, 64% and 48% answered that positive proximal para-esophageal, gastrohepatic ligament and celiac lymph nodes respectively did not prevent esophagectomy for patients with distal esophageal cancer.
Conclusions: EUS-FNA has become widely utilized for accurate staging and directing therapy for esophageal cancer. Significant variability in practice patterns exists between gastroenterologists who perform EUS. Based on this survey, direct communication between the endoscopic ultrasonographer and the thoracic surgeon before and after EUS may help with decisions related to FNA and dilation encountered during the EUS exam as well as decisions pertaining to ultimate appropriateness of esophagectomy.