Endoscopic ultrasonography in esophageal carcinoma: a narrative review

Objective: The goal of this review is to summarize and discuss the role of endoscopic ultrasound (EUS) in the staging and diagnosis of esophageal carcinoma. Background: EUS has a well-established role in the diagnosis and staging of esophageal carcinoma. Technological advancements over the last three decades have increased the ability and utility of EUS; it is a mainstay in the workup of esophageal carcinoma. Methods: Literature review and summary of the available information relating to the use of EUS in practice, along with a review of its limitations in practice. Conclusions: The technology that underlies EUS has evolved over the last three decades. In particular, EUS plays a vital role in determining the extent of local extension of the tumor, which is defined using the T-staging system. Furthermore, it can accurately identify metastases to nearby lymph nodes and liver, and provides the capability of tissue sampling of metastatic disease with fine needle aspiration (FNA), thereby expanding its diagnostic power. As EUS has developed, it has surpassed other modalities for the purposes of both T and N staging of esophageal cancers as delineated by the American Joint Committee on Cancer/ Union for International Cancer Control (AJCC/UICC). EUS is a cornerstone in the multimodal approach to the diagnosis and staging of esophageal cancer which also includes upper endoscopy, cross-sectional imaging, positron emission tomography (PET) scanning, mediastinoscopy and laparoscopy. Limitations of EUS include operator dependence, understaging of the disease in obstructing tumors, difficulty differentiating between T2 and T3 disease, and reduced yield in patients following chemoradiation therapy.