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Endoscopic ultrasound: A “must” only for gastroenterologists?
Abstracts whenever possible while still max1l1uzmg tnmor control. It is very important, for a better planning of chemioradiotherapy, an accnrate evalnation of the depth of the tnmor infiltration (I-statns) and of the presence ofloco-regionallymph node metastasis (N-statns). Endoscopic nltrasonography (EUS) is now nsnally the imaging techniqne of choise for locoregional staging of rectal cancer. The pnrpose of this ongoing stndy is to present preliminary data regarding restaging nsing EUS in patients who nnderwent preoperative chemioradiotherapy. This was part of a research project dealing with molecnlar markers as predictive factors of the neoadjnvant treatment response. Material and methods: From Jannary 2003 to J nne 2005, 38 patients with rectal cancer (25 males, 13 females, age range 36- 75, mean age 62) were investigated nsing flexible sigmoidoscopy and mnltiple biopsies for histological and molecnlar analysis. EUS was performed before chemioradiotherapy. Fonr weeks after the preoperative treatment (radiotherapy at the dosage of 46 Gy in 23 fractions of 2 Gy/day/week combined with chemotherapy with 5flnoronracil at the dosage of200225 mg/mq/day in continnos infnsion) all patients nnderwent restaging by EUS. After six weeks tnmor resection was performed. EUS examination was performed nsing an Olimpns GF UM 20 echo-endoscope with radial scanner (7.5 - 12 Mhz). The EUS staging was compared to the pathology findings based on the snrgical specimens. Results: Overall, the pre-chemioradiotherapy EUS staging was: 6 nTINl, 14 nTINO, 17 nTINl, 1 nT4NO; EUS restaging after preoperative therapy shown: 3 nTINO, 1 nTINl, 13 nTINO, 15 nT3NO, 6 nTINl. Tnmor resection has been performed in 93.7% of patients (36/38), with a pathological staging as follow: 3 complete response have been, 3 pTlNO, 10 pTINO, 1 pTIN2, 7 pT3NO, 12 pTINl. Conclusions: Onr preliminary data show that EUS is an effective preoperative staging techniqne for mnltimodality treatment of stage lIm rectal cancer bnt is not accnrate for determining tnmor response after neoadjnvant chemioradiotherapy.
PO.113 APPROPRIATENESS OF INDICATIONS AND PERFORMANCE OF EUS: A PROSPECTIVE STUDY IN 120 CONSECUTIVE PATIENTS L. Lodi *, E. Lesinigo, F. Rocca
Azienda Ospedaliera, Busto A. Background and aim: There is little known abont the appropriateness of indications of endoscopic nltrasonography (EUS) in an open access centre. Material and methods: From Angnst to October 2005, all the consecntive EUS procednres were categorized by the examiner to the appropriateness of indication as "established", "indicated", "nncertain" in accord once what data that validate EUS nse. The indication for EUS was taken from the patient's hospital charts and records provided by referring physicians. We reported for every patient the indications, specialization of referring physicians, type of exam, feasibility and the examiner's conclnsion There were 120 examinations (120 pts, 71 M, mean age 53±22): 37% were for pancreaticobiliary, 32% for npper gastrointestinal (GI), 30% for lower GI. 71 % were reqnired for diagnostic qnestions, 10% for follow np, 22%.for staging. FNA was performed in 9%. EUS was reqnired by "gastroenterologists" in 39%, "snrgeons" in 35%, "other" in 26%. Results: An analysis ofthe appropriateness of indications according to the speciality of referrig physicians, organ of concern, type of exam, and examiner's conclnsion are show in the table. EUS visnalization of the target organ was satisfactory in 94%. Snrgery and other physicians reqnired more exams for staging than gastroenterogists (28% and 29% vs 8% respectively), instead the follow np exams are reqnired essentially by gastroenterologists and other (14% and 12% vs 2%).
S205
Table 1 Appropriateness Specialization Gastroenterologists Surgeons Others Type of exam Diagnostic Staging Follow up Localization of exam Biliopancreatic GILow GI Upper Conclusion's examiner Diagnosis confirmed Normal Inconclusive
Established (%) W
Indicated (%) 15
Uncertain (%) 24
57.0 76.0 45.0
6.4 14.3 29.0
37.0 9.5 26.0
64.0 82.0 0
21.0 0 0
15.0 18.0 12.0
39 29.7 58.9
2 43.2 O.
4 27.0 41.1
80.9% 51.4% 33.3%
11.9% 37.1% 0
7.1% 11.4% 66.7%
Conclusions: The appropriateness of indications of EUS was good with respect to other gastrointestinal endoscopic examination. Gastroenterologists are overconfident with the method and therefore are inclined to perform it with low appropriateness. The examiner's response answers better to clinical qnestions when the indication is established.
PO.114 ENDOSCOPIC ULTRASOUND: A ''MUST'' ONLY FOR GASTROENTEROLOGISTS? L. Lodi, F. Rocca, E. Lesinigo *
Azienda Ospedaliera "Busto A.", Busto Arsizio Background and aim: Endoscopic ultrasound (EUS) is an accurate imaging modality which has demonstrated a diverse range of diagnostic and interventional application in gastroenterology settings. It is also indicative for the staging of non small celllnng tumors and in the diagnosis of mediastinal masses. It is uncertain what is the level of awareness among chest physicians of the application of EUS. However this modality remains underutilized. Aim: to assess the knowledge of application and utility of EUS among chest physicians. Material and methods: A questionnaire, comprising 8 questions, was designed that addressed availability and application of EUS in pUlmonary disease. The questionnaire was distributed bye-mail to chest physicians to test their awareness of indication. Results: The survey was distributed to 136 chest physicians who works in hospital, ambulatory or private pratice. Only 35 (25.7%) of them replied. Overall the 77% think that EUS is indicative in pre-surgical staging of NSCLC and 57% in the evaluation of mediastinal masses of unknown ongm. Also, the 67% think that EUS is better than TC in accuracy of posterior mediastinal staging, but only 26% have sent a patient for EUS perhaps because the availability is low (22%). Conclusions: Chest physicians demonstrate moderate knowledge ofthe utility of EUS in pulmonary diseases. Also, knowledge of appropriate indication of EUS did not necessarily lead to its use, so EUS is underutilised in clinical settings even because the availability is low. Gastroenterologists need to promote Endoscopic Ultrasound in medical practice outside the gastroenterologic field to disseminate the use of this modality in the community.
PO.113 APPROPRIATENESS OF INDICATIONS AND PERFORMANCE OF EUS: A PROSPECTIVE STUDY IN 120 CONSECUTIVE PATIENTS L. Lodi *, E. Lesinigo, F. Rocca
Azienda Ospedaliera, Busto A. Background and aim: There is little known abont the appropriateness of indications of endoscopic nltrasonography (EUS) in an open access centre. Material and methods: From Angnst to October 2005, all the consecntive EUS procednres were categorized by the examiner to the appropriateness of indication as "established", "indicated", "nncertain" in accord once what data that validate EUS nse. The indication for EUS was taken from the patient's hospital charts and records provided by referring physicians. We reported for every patient the indications, specialization of referring physicians, type of exam, feasibility and the examiner's conclnsion There were 120 examinations (120 pts, 71 M, mean age 53±22): 37% were for pancreaticobiliary, 32% for npper gastrointestinal (GI), 30% for lower GI. 71 % were reqnired for diagnostic qnestions, 10% for follow np, 22%.for staging. FNA was performed in 9%. EUS was reqnired by "gastroenterologists" in 39%, "snrgeons" in 35%, "other" in 26%. Results: An analysis ofthe appropriateness of indications according to the speciality of referrig physicians, organ of concern, type of exam, and examiner's conclnsion are show in the table. EUS visnalization of the target organ was satisfactory in 94%. Snrgery and other physicians reqnired more exams for staging than gastroenterogists (28% and 29% vs 8% respectively), instead the follow np exams are reqnired essentially by gastroenterologists and other (14% and 12% vs 2%).
S205
Table 1 Appropriateness Specialization Gastroenterologists Surgeons Others Type of exam Diagnostic Staging Follow up Localization of exam Biliopancreatic GILow GI Upper Conclusion's examiner Diagnosis confirmed Normal Inconclusive
Established (%) W
Indicated (%) 15
Uncertain (%) 24
57.0 76.0 45.0
6.4 14.3 29.0
37.0 9.5 26.0
64.0 82.0 0
21.0 0 0
15.0 18.0 12.0
39 29.7 58.9
2 43.2 O.
4 27.0 41.1
80.9% 51.4% 33.3%
11.9% 37.1% 0
7.1% 11.4% 66.7%
Conclusions: The appropriateness of indications of EUS was good with respect to other gastrointestinal endoscopic examination. Gastroenterologists are overconfident with the method and therefore are inclined to perform it with low appropriateness. The examiner's response answers better to clinical qnestions when the indication is established.
PO.114 ENDOSCOPIC ULTRASOUND: A ''MUST'' ONLY FOR GASTROENTEROLOGISTS? L. Lodi, F. Rocca, E. Lesinigo *
Azienda Ospedaliera "Busto A.", Busto Arsizio Background and aim: Endoscopic ultrasound (EUS) is an accurate imaging modality which has demonstrated a diverse range of diagnostic and interventional application in gastroenterology settings. It is also indicative for the staging of non small celllnng tumors and in the diagnosis of mediastinal masses. It is uncertain what is the level of awareness among chest physicians of the application of EUS. However this modality remains underutilized. Aim: to assess the knowledge of application and utility of EUS among chest physicians. Material and methods: A questionnaire, comprising 8 questions, was designed that addressed availability and application of EUS in pUlmonary disease. The questionnaire was distributed bye-mail to chest physicians to test their awareness of indication. Results: The survey was distributed to 136 chest physicians who works in hospital, ambulatory or private pratice. Only 35 (25.7%) of them replied. Overall the 77% think that EUS is indicative in pre-surgical staging of NSCLC and 57% in the evaluation of mediastinal masses of unknown ongm. Also, the 67% think that EUS is better than TC in accuracy of posterior mediastinal staging, but only 26% have sent a patient for EUS perhaps because the availability is low (22%). Conclusions: Chest physicians demonstrate moderate knowledge ofthe utility of EUS in pulmonary diseases. Also, knowledge of appropriate indication of EUS did not necessarily lead to its use, so EUS is underutilised in clinical settings even because the availability is low. Gastroenterologists need to promote Endoscopic Ultrasound in medical practice outside the gastroenterologic field to disseminate the use of this modality in the community.