Abstract
Dilation of malignant esophageal strictures often is required to complete staging by endoscopic ultrasound (EUS). This study was designed to determine the successful dilation rate (ability to complete staging) and complication rate of through-the-scope (TTS) balloon dilation for malignant esophageal strictures during EUS. We retrospectively reviewed EUS reports for all cases of primary esophageal cancer staged at five centers between January 2002 and October 2004. All dilations were performed with TTS balloons. Among 272 endoscopic ultrasounds, dilation was required in 77 (28%) and was successful in 73 cases (95%). There was one esophageal perforation after dilation (1.3%; 95% confidence interval (CI), 0.2–7) and one esophageal perforation after EUS without dilation (0.5%; 95% CI, 0.1–2.8; P=0.48 by two-sided Fisher exact test). There were no other major complications. TTS balloon dilation is highly successful in permitting complete staging of obstructing tumors. The rate of complications after dilation with a TTS balloon dilator is low and similar to the baseline rate of EUS in this setting.
Similar content being viewed by others
References
Enzinger P, Mayer R (2003) Esophageal cancer. N Engl J Med 349:2241–2452
Jacobson BC, Hirota WK, Baron TH, Leighton JA, Faigel DO (2003) The role of endoscopy in the assessment and treatment of esophageal cancer. Gastrointest Endosc 57:817–822
Mallery S, Van Dam J (1999) Increased rate of complete EUS staging of patients with esophageal cancer using the non-optical, wire-guided echoendoscope. Gastrointest Endosc 50:53–57
Siemsen M, Svendsen LB, Knigge U, Vilmann P, Jensen F, Rasch L, Stentoft P (2003) A prospective randomized comparison of curved array and radial echoendoscopy in patients with esophageal cancer. Gastrointest Endosc 58:671–676
Vazquez-Sequeiros E, Norton ID, Clain JE, Wang KK, Affi A, Allen M, Deschamps C, Miller D, Salomao D, Wiersema MJ (2001) Impact of EUS-guided fine-needle aspiration on lymph node staging in patients with esophageal carcinoma. Gastrointest Endosc 53:751–757
Vazquez-Sequeiros E, Wiersema M, Clain JE, Norton ID, Levy MJ, Romero Y, Salomao D, Dierkhising R, Zinsmeister AR (2003) Impact of lymph node staging on therapy of esophageal carcinoma. Gastroenterology 125:1626–1635
Van Dam J, Rice TW, Catalano MF, Kirby T, Sivak MV Jr (1993) High-grade malignant stricture is predictive of esophageal tumor stage. Risks of endosonographic evaluation. Cancer 71:2910–2917
Pfau PR, Ginsberg GG, Lew RJ, Faigel DO, Smith DB, Kochman ML (2000) Esophageal dilation for endosonographic evaluation of malignant esophageal strictures is safe and effective. Am J Gastroenterol 95:2813–2815
Wallace MB, Hawes RH, Sahai AV, Van Velse A, Hoffman BJ (2000) Dilation of malignant esophageal stenosis to allow EUS guided fine-needle aspiration: safety and effect on patient management. Gastrointest Endosc 51:309–313
Eloubeidi MA, Wallace MB, Hoffman B, Leveen MB, Van Velse A, Hawes RH, Reed CE (2001) Predictors of survival for esophageal cancer patients with and without celiac axis lymphadenopathy: impact of staging endosonography. Ann Thorac Surg 72:212–220
Kallimanis GE, Gupta PK, AL-Kawas FH, Tio LT, Benjamin SB, Bergagnolli ME, Nguyen CC, Gomes MN, Fleischer DE (1995) Endoscopic ultrasound for staging esophageal cancer, with or without dilation, is clinically important and safe. Gastrointest Endosc 41:540–546
Wiersema MJ, Vilmann P, Giovannini M, Chang KJ, Wiersema LM (1997) Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment. Gastroenterology 112:1087–1095
Mortensen MB, Fristrup C, Holm FS, Pless T, Durup J, Ainsworth AP, Nielsen HO, Hovendal C (2005) Prospective evaluation of patient tolerability, satisfaction with patient information, and complications of endoscopic ultrasonography. Endoscopy 37:146–153
Binmoeller KF, Seifert H, Seitz U, Izbicki JR, Kida M, Soehendra N (1995) Ultrasonic esophagoprobe for TNM staging of highly stenosing esophageal carcinoma. Gastrointest Endosc 41:547–552
AJCC (2002) AJCC cancer staging manual, 6th ed. Springer-Verlag, New York
Colton T (1974) Statistics in medicine. Little, Brown and Company, Boston
Chandrashekar MV, Richardson DL, Preston S, Karat C, Griffin SM (2002) Perforation of a nonobstructing gastro-oesophageal carcinoma by oblique-viewing endoscopic ultrasound videoscope: a need for a safe technique. Endoscopy 34:934
Das A, Sivak M, Chak A (2001) Cervical esophageal perforation during EUS: a national survey. Gastrointest Endosc 53:599–602
Dittler HJ, Siewert JR (1993) Role of endoscopic ultrasonography in esophageal carcinoma. Endoscopy 25:156–161
Bhutani MS, Barde CJ, Markert RJ, Gopalswamy N (2002) Length of esophageal cancer and degree of luminal stenosis during upper endoscopy predict T stage by endoscopic ultrasound. Endoscopy 34:461–463
Mariette C, Balon JM, Maunoury V, Taillier G, Van Seuningen T, Triboulet JP (2003) Value of endoscopic ultrasonography as a predictor of long-term survival in oesophageal carcinoma. Br J Surg 90:1367–1372
Kelly S, Harris KM, Berry E, Hutton J, Roderick P, Cullingworth J, Gathercole L, Smith MA (2001) A systematic review of the staging performance of endoscopic ultrasound in gastro-oesophageal carcinoma. Gut 49:535–539
Catalano M, Van Dam J, Sivak M (1995) Malignant esophageal strictures: staging accuracy of endoscopic ultrasonography. Gastrointest Endosc 41:535–539
Eloubeidi MA, Wallace MB, Reed CE, Hadzijahic N, Lewin DN, Van Velse A, Leveen MB, Etemad B, Matsuda K, Patel RS, Hawes RH, Hoffman BJ (2001) The utility of EUS and EUS-guided fine needle aspiration in detecting celiac lymph node metastasis in patients with esophageal cancer: a single-center experience. Gastrointest Endosc 54:714–719
Parmar K, Zwischenberger JB, Reeves AL, Waxman I (2002) Clinical impact of endoscopic ultrasound-guided fine needle aspiration of celiac lymph nodes (M1a disease) in esophageal cancer. Ann Thorac Surg 73:916–921
Menzel J, Hoepffner N, Nottberg H, Schulz C, Senninger N, Domschke W (1999) Preoperative staging of esophageal carcinoma: miniprobe sonography versus conventional endoscopic ultrasound in a prospective histopathologically verified study. Gastrointest Endosc 31:291–297
Fockens P, van Dulleman H, Tytgat G (1994) Endosonography of stenotic esophageal carcinomas: preliminary experience with an ultra-thin, balloon-fitted ultrasound probe in four patients. Gastrointest Endosc 40:226–228
Chak A, Canto M, Stevens PD, Lightdale CJ, Van de Mierop F, Cooper G, Pollack BJ, Sivak MV Jr (1997) Clinical applications of a new through-the-scope ultrasound probe: prospective comparison with an ultrasound endoscope. Gastrointest Endosc 45:291–295
Hernandez LJ, Jacobson JW, Harris MS (2000) Comparison among the perforation rates of Maloney, balloon, and Savary dilation of esophageal strictures. Gastrointest Endosc 51:460–462
Saeed ZA, Winchester CB, Ferro PS, Michaletz PA, Schwartz JT, Graham DY (1995) Prospective randomized comparison of polyvinyl bougies and through-the-scope balloons for dilation of peptic strictures of the esophagus. Gastrointest Endosc 41:189–195
Scolapio JS, Pasha TM, Gostout CJ, Mahoney DW, Zinmeister AR, Ott BJ, Lindor KD (1999) A randomized prospective study comparing rigid to balloon dilators for benign esophageal strictures and rings. Gastrointest Endosc 50:13–17
Taitelbaum G, Petersen BT, Barkun AN, Chotiprasidhi P, Chuttani R, Liu J (2004) Tools for endoscopic stricture dilation. Gastrointest Endosc 59:753–760
Author information
Authors and Affiliations
Corresponding author
Additional information
Institutions Participating in the Study: Boston University Medical Center, University of Virginia, Oregon Health and Sciences University, University of Chicago, Veterans Administration Healthcare System, Boston, Massachusetts.
Rights and permissions
About this article
Cite this article
Jacobson, B.C., Shami, V.M., Faigel, D.O. et al. Through-the-Scope Balloon Dilation for Endoscopic Ultrasound Staging of Stenosing Esophageal Cancer. Dig Dis Sci 52, 817–822 (2007). https://doi.org/10.1007/s10620-006-9488-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-006-9488-3