PDF icon PDF herunterladen
Open Access
CC BY 4.0 · Endosc Int Open 2025; 13: a26457637
DOI: 10.1055/a-2645-7637
Original article

Safety of surveillance endoscopy and EUS of the esophagus after neoadjuvant chemoradiotherapy: Results from the (pre)SANO trial

Sanjiv S.G. Gangaram Panday  ‡
1   Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands (Ringgold ID: RIN6993)
,
Low Kuan Yean‡
1   Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands (Ringgold ID: RIN6993)
,
Tanya M. Bisseling
2   Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, Netherlands (Ringgold ID: RIN6034)
,
Wouter L. Curvers
3   Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, Netherlands (Ringgold ID: RIN3168)
,
Jolanda M. van Dieren
4   Gastrointestinal oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands (Ringgold ID: RIN1228)
,
Rutger Quispel 
5   Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft, Netherlands (Ringgold ID: RIN84744)
,
Liekele E. Oostenbrug
6   Gastroenterology and Hepatology, Zuyderland Medical Centre Heerlen, Heerlen, Netherlands (Ringgold ID: RIN3802)
,
Andries van der Linden
7   Gastroenterology and Hepatology, ZTG Hospital, Almelo, Netherlands (Ringgold ID: RIN1153)
,
Sietske Corporaal
8   Gastroenterology and Hepatology, Medical Centre Leeuwarden, Leeuwarden, Netherlands (Ringgold ID: RIN4480)
,
Lieke Hol
9   Gastroenterology and Hepatology, Maasstad Hospital, Rotterdam, Netherlands (Ringgold ID: RIN7000)
,
Eva Kouw
10   Gastroenterology and Hepatology, Gelre Hospitals, Apeldoorn, Netherlands (Ringgold ID: RIN240279)
,
Jolein van der Kraan
11   Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, Netherlands (Ringgold ID: RIN4501)
,
Wouter L. Hazen
12   Gastroenterology and Hepatology, Elisabeth TweeSteden Hospital, Tilburg, Netherlands (Ringgold ID: RIN7898)
,
Judith Honing
13   Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands (Ringgold ID: RIN6993)
,
J. Jan B. van Lanschot
1   Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands (Ringgold ID: RIN6993)
,
Bianca Mostert
14   Medical oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands (Ringgold ID: RIN6993)
,
Joost J. Nuyttens
15   Radiotherapy, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands (Ringgold ID: RIN6993)
,
Pieter C. van der Sluis
1   Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands (Ringgold ID: RIN6993)
,
Bas P.L. Wijnhoven
1   Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands (Ringgold ID: RIN6993)
,
Manon C.W. Spaander
13   Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands (Ringgold ID: RIN6993)
,
Sjoerd M. Lagarde
1   Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands (Ringgold ID: RIN6993)
› Institutsangaben
Gefördert durch: ZonMw
Gefördert durch: KWF Kankerbestrijding
› Weitere Informationen
Auch verfügbar aufeRef
  Lizenzen und Reprints
Preview

Abstract

Background and study aims

Active surveillance has been proposed for patients with esophageal cancer and a clinical complete response after neoadjuvant chemoradiotherapy (nCRT). This strategy involves repeated esophagogastroduodenoscopy (EGD) with bite-on-bite biopsies and endoscopic ultrasonography (EUS) with fine-needle aspiration (FNA) to detect tumor regrowth or residual disease. The aim of this study was to assess safety of endoscopic procedures during active surveillance.

Patients and methods

A prospective multicenter cohort including patients who were treated with nCRT for esophageal cancer and who underwent EGD with bite-on-bite biopsies and/or EUS (with fine-needle aspiration) was retrospectively analyzed. The primary outcome was the difference in number of serious adverse events (SAEs) in endoscopic procedures performed within vs. more than 3 months after nCRT. The secondary outcome was mechanical injury.

Results

In 920 patients, 2291 endoscopic procedures were performed (57% EGD combined with EUS, 39% EGD only and 4% EUS only). Of these procedures, 819 (36%) were performed more than 3 months after nCRT in 186 patients. Two gastrointestinal bleedings were reported during endoscopic procedures performed within 3 months after nCRT. One gastrointestinal bleeding and two infections were reported after 3 months following nCRT. Frequency of SAEs before and after 3 months following completion of nCRT was not significantly different (2 vs. 3, odds ratio 2.7, 95% confidence interval 0.3–32.4, P = 0.36).

Conclusions

EGD with bite-on-bite biopsies and EUS with FNA seem to be safe during an active surveillance strategy in esophageal cancer patients after nCRT.

Keywords

Endoscopy Upper GI Tract - Barrett's and adenocarcinoma - Diagnosis and imaging (inc chromoendoscopy, NBI, iSCAN, FICE, CLE) - Endoscopic ultrasonography - Esophageal cancer

Supplementary Material



Publikationsverlauf

Eingereicht: 19. Februar 2025

Angenommen nach Revision: 25. Juni 2025

Accepted Manuscript online:
30. Juni 2025

Artikel online veröffentlicht:
31. Juli 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Sanjiv S.G. Gangaram Panday, Low Kuan Yean, Tanya M. Bisseling, Wouter L. Curvers, Jolanda M. van Dieren, Rutger Quispel, Liekele E. Oostenbrug, Andries van der Linden, Sietske Corporaal, Lieke Hol, Eva Kouw, Jolein van der Kraan, Wouter L. Hazen, Judith Honing, J. Jan B. van Lanschot, Bianca Mostert, Joost J. Nuyttens, Pieter C. van der Sluis, Bas P.L. Wijnhoven, Manon C.W. Spaander, Sjoerd M. Lagarde. Safety of surveillance endoscopy and EUS of the esophagus after neoadjuvant chemoradiotherapy: Results from the (pre)SANO trial. Endosc Int Open 2025; 13: a26457637.
DOI: 10.1055/a-2645-7637
 

  • References

  • 1 Eyck BM, van Lanschot JJB, Hulshof M. et al. Ten-year outcome of neoadjuvant chemoradiotherapy plus surgery for esophageal cancer: the randomized controlled CROSS Trial. J Clin Oncol 2021; 39: 1995-2004
    Suche in Google Scholar
  • 2 Noordman BJ, Verdam MGE, Lagarde SM. et al. Impact of neoadjuvant chemoradiotherapy on health-related quality of life in long-term survivors of esophageal or junctional cancer: results from the randomized CROSS trial. Ann Oncol 2018; 29: 445-451
    Suche in Google Scholar
  • 3 van der Werf LR, Busweiler LAD, van Sandick JW. et al. Reporting national outcomes after esophagectomy and gastrectomy according to the Esophageal Complications Consensus Group (ECCG). Ann Surg 2020; 271: 1095-1101
    Suche in Google Scholar
  • 4 Shapiro J, van Lanschot JJB, Hulshof M. et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol 2015; 16: 1090-1098
    Suche in Google Scholar
  • 5 Noordman BJ, Spaander MCW, Valkema R. et al. Detection of residual disease after neoadjuvant chemoradiotherapy for oesophageal cancer (preSANO): a prospective multicentre, diagnostic cohort study. Lancet Oncol 2018; 19: 965-974
    Suche in Google Scholar
  • 6 van der Wilk BJ, Eyck BM, Wijnhoven BPL. et al. LBA75 Neoadjuvant chemoradiotherapy followed by surgery versus active surveillance for oesophageal cancer (SANO-trial): A phase-III stepped-wedge cluster randomised trial. Ann Oncology 2023; 34: S1317
    Suche in Google Scholar
  • 7 Azam M, Hudgi A, Uy PP. et al. Safety of endoscopy in patients undergoing treatments with antiangiogenic agents: A 5-year retrospective review. World J Gastrointest Endosc 2022; 14: 416-423
    Suche in Google Scholar
  • 8 de Moura DTH, McCarty TR, Jirapinyo P. et al. EUS-guided fine-needle biopsy sampling versus FNA in the diagnosis of subepithelial lesions: a large multicenter study. Gastrointest Endosc 2020; 92: 108-119 e103
    Suche in Google Scholar
  • 9 Wolfsen HC, Hemminger LL, Achem SR. et al. Complications of endoscopy of the upper gastrointestinal tract: a single-center experience. Mayo Clin Proc 2004; 79: 1264-1267
    Suche in Google Scholar
  • 10 Zubarik R, Eisen G, Mastropietro C. et al. Prospective analysis of complications 30 days after outpatient upper endoscopy. Am J Gastroenterol 1999; 94: 1539-1545
    Suche in Google Scholar
  • 11 van der Bogt RD, van der Wilk BJ, Oudijk L. et al. Bite-on-bite biopsies for the detection of residual esophageal cancer after neoadjuvant chemoradiotherapy. Endoscopy 2022; 54: 1131-1138
    Suche in Google Scholar
  • 12 Afifi A, Powerski M, Jechorek D. et al. Radiation-induced damage in the upper gastrointestinal tract: clinical presentation, diagnostic tests and treatment options. Best Pract Res Clin Gastroenterol 2020; 48–49: 101711
    Suche in Google Scholar
  • 13 Noordman BJ, Wijnhoven BPL, Lagarde SM. et al. Neoadjuvant chemoradiotherapy plus surgery versus active surveillance for oesophageal cancer: a stepped-wedge cluster randomised trial. BMC Cancer 2018; 18: 142
    Suche in Google Scholar
  • 14 Eyck BM, van der Wilk BJ, Noordman BJ. et al. Updated protocol of the SANO trial: a stepped-wedge cluster randomised trial comparing surgery with active surveillance after neoadjuvant chemoradiotherapy for oesophageal cancer. Trials 2021; 22: 345
    Suche in Google Scholar
  • 15 Nass KJ, Zwager LW, van der Vlugt M. et al. Novel classification for adverse events in GI endoscopy: the AGREE classification. Gastrointest Endosc 2022; 95: 1078-1085 e1078
    Suche in Google Scholar
  • 16 Eyck BM, Onstenk BD, Noordman BJ. et al. Accuracy of detecting residual disease after neoadjuvant chemoradiotherapy for esophageal cancer: A systematic review and meta-analysis. Ann Surg 2020; 271: 245-256
    Suche in Google Scholar
  • 17 Garcia-Aguilar J, Patil S, Gollub MJ. et al. Organ preservation in patients with rectal adenocarcinoma treated with total neoadjuvant therapy. J Clin Oncol 2022; 40: 2546-2556
    Suche in Google Scholar
  • 18 van der Valk MJM, Hilling DE, Bastiaannet E. et al. Long-term outcomes of clinical complete responders after neoadjuvant treatment for rectal cancer in the International Watch & Wait Database (IWWD): an international multicentre registry study. Lancet 2018; 391: 2537-2545
    Suche in Google Scholar
  • 19 Adebahr S, Schimek-Jasch T, Nestle U. et al. Oesophagus side effects related to the treatment of oesophageal cancer or radiotherapy of other thoracic malignancies. Best Pract Res Clin Gastroenterol 2016; 30: 565-580
    Suche in Google Scholar
  • 20 Sieg A, Hachmoeller-Eisenbach U, Eisenbach T. Prospective evaluation of complications in outpatient GI endoscopy: a survey among German gastroenterologists. Gastrointest Endosc 2001; 53: 620-627
    Suche in Google Scholar
  • 21 Cheung KS, Leung WK. Gastrointestinal bleeding in patients on novel oral anticoagulants: Risk, prevention and management. World J Gastroenterol 2017; 23: 1954-1963
    Suche in Google Scholar
  • 22 Gimbel ME, Minderhoud SCS, Ten Berg JM. A practical guide on how to handle patients with bleeding events while on oral antithrombotic treatment. Neth Heart J 2018; 26: 341-351
    Suche in Google Scholar
  • 23 Wang KX, Ben QW, Jin ZD. et al. Assessment of morbidity and mortality associated with EUS-guided FNA: a systematic review. Gastrointest Endosc 2011; 73: 283-290
    Suche in Google Scholar