Seven studies were included in the review. Five pre-test/post-test case series (n=877 patients) reported on the impact of endoscopic ultrasound on pre-test management plan. None of the studies: recruited a consecutive series of patients based on clinical presentation; included independent assessment of the adequacy of pre-test work-up/diagnosis; or included the contribution of endoscopic ultrasound to the management decision. One study assessed concordance between assessors rather than per patient change to management plan. Two studies provided accuracy data for endoscopic ultrasound. None of the studies reported the effectiveness of treatments provided. Overall, the generalisability of data was limited by determination of management plan with operators or setting not typical of clinical practice. Two retrospective cohort studies (n=309 patients) reported survival data in patients staged with and without endoscopic ultrasound, using a historical control group; neither study reported inclusion of consecutive patients; the potential for selection bias and differences in concomitant therapies was high.
Patient management: Endoscopic ultrasound changed management in 24 to 29% of patients (two studies). Combining data on endoscopic ultrasound for staging and/or diagnosis (two studies), endoscopic ultrasound changed management in 32 to 55% of patients; further investigations were avoided in 14 to 33% of these patients (two studies), and surgery was avoided in 18% (one study). Data on the avoidance of surgery in patients receiving endoscopic ultrasound for the staging of oesophageal cancer were not reported separately by any study; surgery was avoided in 10 to 16% of patients with mixed indications (three studies).
Survival: One study (n=167) found that staging with endoscopic ultrasound increased survival (adjusted HR 0.66, 95% CI 0.47 to 0.90), and decreased tumour recurrence (adjusted HR 0.63, 95% CI 0.43 to 0.87). A second study (n=142 patients) reported survival data for patients undergoing surgical resection, rather than for all patients tested; it found that median survival times and rates of unnecessary laparotomy were similar in patients staged with and without endoscopic ultrasound.