Utility of EUS following endoscopic polypectomy of high-risk rectosigmoid lesions

Leticia P. Luz, Gregory A. Cote, Mohammad A. Al-Haddad, Lee McHenry, Julia K. LeBlanc, Stuart Sherman, Daniel M. Moreira, Ihab I. El Hajj, Kathleen McGreevy, John DeWitt

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

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 and Methods: Patients referred for EUS following attempted endoscopic resection of a high-risk rectal neoplasm, defi ned as a tubulovillous adenoma, tubular adenoma with high-grade dysplasia, carcinoid, carcinoma in-situ or adenocarcinoma (CA). Interventions: Sigmoidoscopy ± mucosal biopsy and EUS ± fi ne-needle aspiration (FNA) to evaluate for: (1) Residual polyp/tumor in the rectal wall or (2) peritumoral adenopathy. Main Outcome: Sensitivity and specifi city 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 defi ned 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 fi nal diagnosis of CA (n = 38) and non-CA (n = 32) were identifi ed. There was no difference between the sensitivity and specifi city 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 identifi ed 3 masses missed by WLE, all in the CA group. A malignant (n = 2) or benign (n = 3) node was identifi ed 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 identifi ed 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.

Original languageEnglish (US)
Pages (from-to)137-144
Number of pages8
JournalEndoscopic Ultrasound
Volume4
Issue number2
DOIs
StatePublished - 2015

Keywords

  • Colonic polyps
  • Endosonography
  • Rectal neoplasms

ASJC Scopus subject areas

  • Hepatology
  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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