Endoscopic Ultrasound Stagingof Esophageal Cancer

Esophageal cancer has increased in incidence over the last several decades and is now the sixth leading cause of all cancer deaths, with more than 500,000 deaths in 2018. The 2 most common types of esophageal cancer, squamous cell cancer and esophageal adenocarcinoma, make up nearly 95% of diagnoses. Based on the global distribution of these histologic types, esophageal adenocarcinoma is more common in the United States while squamous cell cancer is more common throughout the world. For both the squamous cell cancer and esophageal adenocarcinoma variants of esophageal cancer, the most important step in determining prognosis and survival is accurate staging. Endoscopy, computed tomography, whole-body positron emission tomography with 18-fluorodeoxyglucose, and endoscopic ultrasound (EUS) all have important roles in the diagnosis and staging of esophageal cancer. EUS is key for locoregional staging and guides treatment planning of esophageal cancer in the absence of distant metastases. EUS has been shown to improve survival across various stages of esophageal cancer and to have a positive financial impact in cost-effectiveness analyses. This article describes current EUS technology and the role of EUS in esophageal cancer staging, as well as the applications, challenges, and limitations of EUS in the management of this disease.