Endosonography in the evaluation of patients with Barrett's esophagus and high-grade dysplasia

Gastrointest Endosc. 1994 Mar-Apr;40(2 Pt 1):207-12. doi: 10.1016/s0016-5107(94)70168-7.


Endosonography, which provides high-resolution images of the esophageal wall, could potentially detect carcinoma not visible endoscopically in patients with Barrett's esophagus and high-grade dysplasia. We studied the ability of endosonography to detect early esophageal carcinoma in 9 patients with Barrett's esophagus and high-grade dysplasia who were candidates for esophagectomy. Pre-operative endoscopy and biopsy revealed high-grade dysplasia without evidence of carcinoma in all patients. Pre-operative endosonographic evaluations were compared to the pathologic diagnoses of resected specimens. Post-operatively, 3 of the 9 patients were found to have intra-mucosal carcinoma. Endosonography identified a tumor in only 1 of these 3 patients and over-staged it as invasive carcinoma (T2, N1). In 2 of the 6 patients without intra-mucosal carcinoma, endosonography predicted invasive carcinoma (T2, N0). Endoscopy revealed mucosal nodularity in each of the 3 over-staged patients. We conclude that recommendation of the routine use of endosonography to determine the need for surgery in patients with Barrett's esophagus and high-grade dysplasia would be premature, because the current generation of echo-endoscopes does not reliably differentiate between benign and malignant wall thickening.

MeSH terms

  • Adenocarcinoma / diagnostic imaging*
  • Adenocarcinoma / pathology
  • Adenocarcinoma / surgery
  • Aged
  • Barrett Esophagus / diagnostic imaging*
  • Barrett Esophagus / pathology
  • Barrett Esophagus / surgery
  • Esophageal Neoplasms / diagnostic imaging*
  • Esophageal Neoplasms / pathology
  • Esophageal Neoplasms / surgery
  • Esophagectomy
  • Esophagoscopy
  • Esophagus / pathology*
  • Humans
  • Male
  • Ultrasonography / methods