Utility of EUS following endoscopic polypectomy of high-risk rectosigmoid lesions
Leticia P Luz1, Gregory A Cote2, Mohammad A Al-Haddad2, Lee McHenry2, Julia K LeBlanc2, Stuart Sherman2, Daniel M Moreira3, Ihab I El Hajj2, Kathleen McGreevy2, John DeWitt2
1 Medicine Service, Division of Gastroenterology, Richard L. Roudebush VA Medical Center, Indianapolis, IN; Department of Internal Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
2 Department of Internal Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
3 Department of Urology, Mayo Clinic, Rochester, MN, USA
Associate Professor of Medicine, Director of Endoscopic Ultrasound and Endoscopic Innovation, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 550 N. University Blvd, UH 4100
Source of Support: None, Conflict of Interest: None
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, defined as a tubulovillous adenoma, tubular adenoma with high-grade dysplasia, carcinoid, carcinoma in-situ or adenocarcinoma (CA). Interventions: Sigmoidoscopy ± mucosal biopsy and EUS ± fine-needle aspiration (FNA) to evaluate for: (1) Residual polyp/tumor in the rectal wall or (2) peritumoral adenopathy. Main Outcome: Sensitivity and specificity 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 defined 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 final diagnosis of CA (n = 38) and non-CA (n = 32) were identified. There was no difference between the sensitivity and specificity 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 identified 3 masses missed by WLE, all in the CA group. A malignant (n = 2) or benign (n = 3) node was identified 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 identified 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.