Usefulness of endoscopic ultrasonography in preoperative gastric cancer staging: diagnostic yield and therapeutic impact

Objectives: to evaluate the diagnostic yield of endoscopic ul trasonography in loco-regional staging of gastric cancer in our medium and to determine the impact of this technique on later therapeutic management. Material and methods: this is a retrospective study carried out on patients histologically diagnosed with gastric adenocarcino ma who had been referred for endoscopic ultrasonographic exa mination. The technique results were compared with those obtai ned from surgical samples and/or from exploratory laparoscopylaparotomy. We compared the initial therapeutic decision based on conventional diagnostic techniques with the final therapeutic management based on the endoscopic ultrasonography results. Results: forty-six patients with gastric adenocarcinoma were included in the study (a reference exploration was available in 36 cases). Diagnostic precision was 70% in stage T, while in stages T1, T2, T3 y T4 was 100, 38, 82, and 100%, respectively. The sensitivity and specificity to differentiate T1-2 from T3-4 was 94 and 85%, respectively. We could not identify factors associated with obtaining a correct diagnosis in staging T. Diagnostic preci sion was 72% for stage N (N0: 58%; Nx 88%). The presence of free perigastric fluid was identified in 7 cases; the presence of pe ritoneal carcinomatosis was later confirmed in 5 of these. The re sult of endoscopic ultrasonography led to a modification in the subsequent therapeutic management in 13 patients (28%). Conclusions: endoscopic ultrasonography is a useful techni que for loco-regional staging of gastric adenocarcinoma, which may have important implications in the therapeutic management of these patients.