In our study, no statistically significant difference in proportion of patients with EUS findings suspicious for invasion regarding the presence of any visible lesion was noted. When

the type of lesion was analyzed, no statistically significant association between significant EUS findings and flat lesions (type 0-IIb) was found. Our results are consistent with the most recently published studies about this topic. Pech et al. (51) reported an unsatisfactory accuracy rate of 74% for T stage and 73% for N stage when comparing EUS staging before surgery with esophagectomy staging (n=179). T2 cancers are the most frequently overstaged by EUS, leading Inhibitors,research,lifescience,medical in a significant impact on making treatment decisions. Similarly to our data, Thomas et al. (52) Inhibitors,research,lifescience,medical reported that the role of EUS in the pretherapeutic algorithm for early Barrett’s neoplasia should be reconsidered with submucosal invasion detected only in 26% of patients

(n=50). The value of EUS is even more limited in patients with flat VL (0-IIb), where all of lesions are confined to the mucosa. In the same direction, a recent retrospective analysis of 131 patients with early esophageal cancer performed by the Amsterdam group (53) concluded that EUS exam has no clinical impact on the decision making for treatment. 24% of the Inhibitors,research,lifescience,medical 105 patients with unremarkable EUS findings underwent surgery after EMR due to submucosal involvement, positive resection margins, lymphovascular invasion or poor differentiation grade. In the other hand, 38% of the 26 patients with suspected submucosal invasion or LNM according to the EUS exams were successfully treated by endoscopic approach. A recent review established a global incidence of incidental findings (in radiological Inhibitors,research,lifescience,medical tests of 23.6%, Inhibitors,research,lifescience,medical which were detected in higher frequencies when CT scan was performed.

However, none of the included studies in this review had reported data from EUS exams (54). In this series, 10% (n=11) of patients had an additional diagnosis due to the EUS exam; in 6 of the 11 patients, these incidental findings were considered as significant according to the need for further learn more investigations, treatment or follow up (4 pancreatic lesions and 1 mediastinal mass). The only study published to date, which reports incidental finding rates on EUS (55), Annual Review of Biochemistry found an overall 38.5% incidence of additional ancillary diagnoses in 239 consecutive EUS exams performed for a variety of indications. Of these incidentally found conditions, 11.3% were considered clinically significant. These findings raise the question if a complete endosonographic exploration should be performed in every patient. There are several limitations to our study, including a retrospective design based on the information provided by clinical reports from a single center. This study presents a markedly low rate of patients with TNM staging reported on the final EUS diagnosis.