Accuracy of the Hyperband EUS in Superficial Neoplasia in Barrett''s Esophagus

Rationale: Routine radial EUS has been felt to be inadequate to stage mucosal and submucosal neoplasia in Barrett's Esophagus (BE). The newly developed hyperband (Olympus GF-UM 160) echoendoscope uses composite piezo-electric material provides broadband scanning with four different frequencies, resulting in high-resolution ultrasound images. The yield and accuracy of this instrument has not been reported previously in superficial neoplasia in Barrett's esophagus. Aim: To assess the accuracy of the GF-UM 160 echoendoscope in the staging of neoplastic lesions arising in BE using endoscopic resection (EMR) specimens as the gold standard. Methods: A prospectively collected cohort of 33 consecutive patients with HGD/Carcinoma and BE seen at the Mayo Barrett's Unit was studied. All patients underwent a standard protocol assessment with EGD, 4 quadrant biopsies every centimeter. Visible lesions were resected using either the Olympus EMR kit (88%) or the Wilson-Cook Duette Multi-Band mucosectomy system (12%). Staging was performed prior to resection in all patients using the Olympus GF-UM 160 instrument by a single experienced endosonographer. Results: 25 (76%) were males. The mean age was 68 years (SEM 1.7). The pre-procedure diagnosis was HGD in 24 patients (73%) and cancer in the remainder (27%). The median BE segment length was 2.5cm (IQR 1–6). 73% of patients had a visible nodule/mucosal irregularity on EGD. Staging with EUS revealed no abnormality (uT0) in 88%, uT1 disease in 9% (mucosal disease in 1 patient and submucosal in 2 patients), and uT2 disease in 3%. No patients had metastatic lymph nodes. 58% of patients underwent 1 EMR and the remainder had 2–6 EMRs. EMR pathology revealed carcinoma in 5 patients (submucosal in 4; mucosal in 1). 43% of the resected lesions contained only HGD. 3 patients with submucosally invasive cancer underwent esophagectomy; one with mucosal cancer was treated with EMR alone. The patient with T2 cancer elected to pursue comfort care only. Discussion: The sensitivity of Hyperband EUS in detecting cancers was 80% with a specificity of 100%. EUS hyperband staging of cancers in terms of mucosal/submucosal extent correlated well with staging on histopathology. Hyperband EUS accurately predicted EMR resectability of lesions in all patients.