The prediction value of EUS versus magnifying EGD for the depth of invasion for early UGI cancers

Endoscopic submucosal dissection (ESD) has been widely em¬ployed as a treatment option for differentiated early gastric can¬cer (EGC) with minimal risk of lymph node metastases because it is less invasive and offers a better quality of life than surgical resection. Therefore, the proper selection of candidates for ESD is important in order to avoid both unnecessary surgery and the need for retreatment after ESD. Accurate preoperative prediction of invasion depth in EGC is essential for the selection of patients for ESD.
Conventional endoscopy, with magnifying narrow-band imaging has been a useful diagnostic modality for estimating the depth of invasion for EGC. Studies have shown an accuracy of 70 to 84% for differentiating invasion to mucosa or submucosa. However, the role of endoscopic ultrasound (EUS) is still controversial. Reports comparing the accuracy of EUS in combination with conventional endoscopy have produced inconsistent results. We have performed a retrospective analysis of all gastric and esophageal ESD cases (total 250 cases) for neoplasia in Prince of Wales Hospital from Jan 2004 to Jan 2021. The aim of the study is to examine the correlation of magnifying EGD and EUS findings with final histology and to see if EUS has additional benefit in predicting depth of invasion. Patients baseline demographics, magnifying EGD findings, EUS findings, final histology, overall survival, recurrence-free survival were recorded. A logistics regression on the predicting factors of depth of invasion in final pathology and Kaplan Meier curve on the survival analysis with correlation with the histology were performed.
A literature review on the optimal way of predicting invasion, especially for gastric cancer will be discussed.