Role of endosonography prior to endoscopic treatment of esophageal cancer

Esophageal cancer is a common disease with poor survival rates. The treatment and prognosis of patients with esophageal cancer depend on the stage of the disease. Accurate clinical staging is critical for stratifying patients for treatment. While advanced cancers are generally treated by neoadjuvant chemoradiotherapy and surgery, early cancers may be amendable to endoluminal, minimally invasive treatments, thus saving patients from unnecessary surgery. Endoscopic ultrasonography has a major role in loco-regional staging of esophageal cancer and should be performed in all patients after excluding significant comorbidities and distant metastases. However, the role of endosonography seems to be limited in early cancer, since it does not determine the depth of invasion with sufficient accuracy. This can prove decisive for treatment planning. Despite substantial efforts, its main role in early cancer is still confined to ruling out the deeper involvement or lymph node metastasis. A preferable treatment is for patients to undergo a diagnostic endoscopic resection, which facilitates correct pathological staging and final treatment decision.