The role of endoscopic ultrasonography in Barrett's esophagus and early esophageal cancer

Endoscopic ultrasonography is established as the most accurate modality for the local staging of esophageal neoplasms. The minimally invasive management of high-grade dysplasia and early intramucosal cancer arising in Barrett's esophagus is in evolution, with the emergence of endoscopically delivered ablative therapies challenging the more conventional treatment of esophagectomy. The precise staging of these patients for depth of tumor penetration, lymph node status, and potential hematogenous metastases, is therefore crucial before considering a minimally invasive treatment strategy. The evidence suggests that endoscopic ultrasonography can successfully differentiate early (T1) from advanced intramural disease, but it is poor at differentiating mucosal from submucosal lesions. Its role in managing patients with early disease therefore appears to be limited, although it does appear valuable for detecting associated malignant lymphadenopathy.