The factors influencing the accuracy of pre‐operative endoscopic ultrasonography assessment in endoscopic treatments for gastrointestinal tumors

Abstract

Abstract Background This retrospective study aimed to evaluate the factors influencing the accuracy of Endoscopic Ultrasonography (EUS) as a preoperative assessment for gastrointestinal tumors. Methods A total of 261 patients with 264 gastrointestinal tumors were enrolled in the study. The parameters of the gastrointestinal lesions examined under EUS and their pathology were recorded and analyzed. Results The accuracy of EUS for detecting intramucosal lesions and subepithelial lesions (SELs) were 83.6% and 91.4%, respectively. One hundred and ninety‐four (73.5%) lesions originated from the mucous layer, as determined by pre‐operation EUS examinations. The accuracy of EUS in predicting the correct T stage for intramucosal lesions in the gastric region, esophagus, and colorectum was 77%, 71.8%, and 84.6%, respectively. According to the Paris endoscopic classification, the distribution of macroscopic patterns was different between the EUS‐pathology conformity and nonconformity groups (p = 0.018). In the nonconformity group, 48.6% of erosive lesions were classified as 0‐IIc, 0‐IIa + IIc, 0‐IIc + IIa or 0‐III macroscopic patterns compared with 26% patients in the conformity group (p = 0.025). Univariate analyses demonstrated that ulcerative lesions (OR = 7.516, 95% Confidence Interval [CI] 2.574–21.952, p < 0.001), location at the cardia of the stomach (OR = 3.619, 95%CI 1.076–12.168, p = 0.038), malignant tumor (OR = 2.920, 95%CI 1.339–6.368, p = 0.007) were significantly associated with EUS inaccuracy. Multivariate logistic regression analyses showed that ulcer was an independent risk factor associated with EUS inaccuracy, with odds ratios of 5.094 (95% CI: 1.641–15.807, p = 0.005). Conclusions Our findings suggested that EUS is a reliable and easy‐to‐use diagnostic tool in decision‐making regarding appropriate endoscopic treatment for gastrointestinal tumors. However, the diagnostic accuracy of EUS appeared questionable in the presence of ulceration.

Keywords

• diagnostic accuracy
• endoscopic submucosal dissection
• endoscopic ultrasonography
• gastrointestinal superficial tumors
• pre‐operative assessments