Diagnosis of recurrent upper gastrointestinal cancer at the surgical anastomosis by endoscopic ultrasound

Endoscopic ultrasonography (EUS) with a 7.5 MHz transducer was used to examine the upper gastrointestinal tract in 40 patients who had resection of esophageal or gastric cancer, and symptoms suggesting recurrence. There were 24 patients with recurrent cancer in the area of the surgical anastomosis (based on endoscopic biopsy in 16, repeat endoscopy in 2, and surgery after negative endoscopy in 6), and 16 patients without anastomotic recurrence. With EUS, locally recurrent cancer was correctly identified by nodular hypoechoic thickening at the anastomosis in 23 of 24 patients with one false negative; absence of anastomotic recurrence was correctly diagnosed in 13 of 16 with three false positives (sensitivity, 95%; specificity, 80%; positive predictive accuracy, 88%; and negative predictive accuracy, 92%). High frequency EUS with limited depth of penetration is not effective for evaluation of distant metastases, but is ideally suited for diagnosis of locally recurrent esophageal and gastric cancer.