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 journalArticle

5 Citations (Scopus)

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

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Endoscopy
Light
Needles
Neoplasms
Polyps
Biopsy
Adenoma
Sigmoidoscopy
Carcinoma in Situ
Carcinoid Tumor
Residual Neoplasm
Rectal Neoplasms
Tertiary Care Centers
Adenocarcinoma
Lymph Nodes

Keywords

  • Colonic polyps
  • Endosonography
  • Rectal neoplasms

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology
  • Hepatology

Cite this

Utility of EUS following endoscopic polypectomy of high-risk rectosigmoid lesions. / Luz, Leticia P.; Cote, Gregory A.; Al-Haddad, Mohammad A.; McHenry, Lee; LeBlanc, Julia K.; Sherman, Stuart; Moreira, Daniel M.; El Hajj, Ihab I.; McGreevy, Kathleen; DeWitt, John.

In: Endoscopic Ultrasound, Vol. 4, No. 2, 2015, p. 137-144.

Research output: Contribution to journalArticle

Luz, LP, Cote, GA, Al-Haddad, MA, McHenry, L, LeBlanc, JK, Sherman, S, Moreira, DM, El Hajj, II, McGreevy, K & DeWitt, J 2015, 'Utility of EUS following endoscopic polypectomy of high-risk rectosigmoid lesions', Endoscopic Ultrasound, vol. 4, no. 2, pp. 137-144. https://doi.org/10.4103/2303-9027.156744
Luz, Leticia P. ; Cote, Gregory A. ; Al-Haddad, Mohammad A. ; McHenry, Lee ; LeBlanc, Julia K. ; Sherman, Stuart ; Moreira, Daniel M. ; El Hajj, Ihab I. ; McGreevy, Kathleen ; DeWitt, John. / Utility of EUS following endoscopic polypectomy of high-risk rectosigmoid lesions. In: Endoscopic Ultrasound. 2015 ; Vol. 4, No. 2. pp. 137-144.
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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.",
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T1 - Utility of EUS following endoscopic polypectomy of high-risk rectosigmoid lesions

AU - Luz, Leticia P.

AU - Cote, Gregory A.

AU - Al-Haddad, Mohammad A.

AU - McHenry, Lee

AU - LeBlanc, Julia K.

AU - Sherman, Stuart

AU - Moreira, Daniel M.

AU - El Hajj, Ihab I.

AU - McGreevy, Kathleen

AU - DeWitt, John

PY - 2015

Y1 - 2015

N2 - 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.

AB - 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.

KW - Colonic polyps

KW - Endosonography

KW - Rectal neoplasms

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