Local Recurrence Detection Following Transanal Excision Facilitated by EUS-FNA
ABSTRACT BACKGROUND/ AIMS: Local excision is an alternative management approach for early rectal cancers and patients unfit for radical surgery. It is associated with a high local recurrence rate. Our aims were to evaluate the rate, pattern, method of local recurrence detection, the opportunity for salvage resection and finally to explore the utility of endoscopic ultrasound fine needle aspiration during surveillance.
A retrospective, non-controlled, cohort study from a single tertiary referral center comprised of patients undergoing surveillance following a transanal excision.
Post-operative surveillance was performed in 155 transanal excision patients of which 46 (30%) underwent =1 endoscopic ultrasound examinations. Intra and extra luminal recurrence (n=16/24; (67%)) was detected more frequently in the endoscopic ultrasound surveillance population, p=0.0008. Mucosal scar biopsy (n=10/16;63%) and endoscopic ultrasound fine needle aspiration (6/16; 38%) of either a lymph node or the deep rectal wall were the methods for establishing local recurrence. An unremarkable proctoscopy with endoscopic ultrasound fine needle aspiration positive cytological findings was noted in 4 (9%) of the patients.
Local recurrence following transanal excision is often in an intraluminal location. Endoscopic ultrasound fine needle aspiration confirmed nodal metastases in mesenteric and extra mesenteric locations more frequently than subepithelial locations.
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ABSTRACT: The utility of endoscopic ultrasound (EUS) compared with standard white light endoscopy (WLE) following recent polypectomy of high-risk colorectal polyps is unknown. To assess the incremental yield of EUS after endoscopic polypectomy of a high-risk rectal lesion. Retrospective cohort. Tertiary referral center. 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). Sigmoidoscopy ± mucosal biopsy and EUS ± fine-needle aspiration (FNA) to evaluate for: (1) Residual polyp/tumor in the rectal wall or (2) peritumoral adenopathy. 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. 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. Retrospective design, incomplete follow-up in some patients. 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.Gastrointestinal Endoscopy 05/2014; 79(5):AB406. DOI:10.1016/j.gie.2014.02.534 · 4.90 Impact Factor