Is endoscopic ultrasonography useful for endoscopic submucosal dissection?

Area of Science:

• Gastroenterology
• Oncology
• Medical Imaging

Background:

• Endoscopic submucosal dissection (ESD) is a key technique for treating early gastrointestinal (GI) cancers and precancerous lesions.
• Submucosal tumors (SMTs) can also be effectively removed using ESD, especially larger lesions, ensuring complete resection.

Approach:

• Endoscopic ultrasonography (EUS) is utilized for preoperative evaluation, accurately assessing lesion invasion depth.
• EUS-guided fine-needle aspiration enhances diagnostic accuracy for malignant lymph nodes.
• EUS aids in characterizing early GI cancers with suspected submucosal invasion and diagnosing SMTs.

Key Points:

• During ESD, EUS identifies surrounding vasculature and fibrosis, predicting procedure duration and reducing bleeding/perforation risks.
• EUS-guided injection prior to ESD ensures procedural safety and accuracy.
• EUS plays a crucial role in optimizing ESD procedures.

Conclusions:

• While EUS is valuable in ESD, its diagnostic accuracy in staging lesions can be controversial, sometimes leading to under or overstaging.
• This review synthesizes current research on the integral role of EUS in conjunction with ESD.