Download PDF
Open Access
CC BY 4.0 · Endoscopy
DOI: 10.1055/a-2776-5896
Original article

The value of routine endoscopic ultrasound in patients with esophageal cancer undergoing active surveillance after neoadjuvant chemoradiotherapy

Authors

  • Sanjiv S. G. Gangaram Panday 

    1   Department of Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands (Ringgold ID: RIN6993)

  • Matteo Pittacolo

    1   Department of Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands (Ringgold ID: RIN6993)
    2   Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova, Italy (Ringgold ID: RIN9308)

  • Sjoerd M. Lagarde

    1   Department of Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands (Ringgold ID: RIN6993)

  • Bianca Mostert

    3   Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands (Ringgold ID: RIN6993)

  • Judith Honing

    4   Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands (Ringgold ID: RIN6993)

  • J. Jan B. van Lanschot

    1   Department of Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands (Ringgold ID: RIN6993)

  • Tanya M. Bisseling

    5   Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands (Ringgold ID: RIN6034)

  • Erik J. Schoon

    6   Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands (Ringgold ID: RIN3168)

  • Jolanda M. van Dieren

    7   Department of Gastrointestinal Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands (Ringgold ID: RIN1228)

  • Rutger Quispel 

    8   Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft, The Netherlands (Ringgold ID: RIN84744)

  • Liekele E. Oostenbrug

    9   Department of Gastroenterology and Hepatology, Zuyderland Medical Centre, Heerlen, The Netherlands (Ringgold ID: RIN3802)

  • Andries van der Linden

    10   Department of Gastroenterology and Hepatology, ZGT Hospital, Almelo, The Netherlands (Ringgold ID: RIN1153)

  • Sietske Corporaal

    11   Department of Gastroenterology and Hepatology, Frisius MC Leeuwarden, Leeuwarden, The Netherlands (Ringgold ID: RIN4480)

  • Lieke Hol

    12   Department of Gastroenterology and Hepatology, Maasstad Hospital, Rotterdam, The Netherlands (Ringgold ID: RIN7000)

  • Eva Kouw

    13   Department of Gastroenterology and Hepatology, Gelre Hospitals, Apeldoorn, The Netherlands (Ringgold ID: RIN72485)

  • Jurjen J. Boonstra

    14   Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands (Ringgold ID: RIN4501)

  • Wouter L. Hazen

    15   Department of Gastroenterology and Hepatology, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands (Ringgold ID: RIN7898)

  • Erik Vegt

    16   Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands (Ringgold ID: RIN6993)

  • Manon C. W. Spaander 

    4   Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands (Ringgold ID: RIN6993)

  • Bas P. L. Wijnhoven

    1   Department of Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands (Ringgold ID: RIN6993)
    • on behalf of the SANO Study Group*

Supported by: ZonMw 843004104
Supported by: KWF Kankerbestrijding 10825
Further Information
Also available at
  Permissions and Reprints


Graphical Abstract

Abstract

Background

Active surveillance for esophageal cancer after neoadjuvant chemoradiotherapy (nCRT) involves repeated diagnostic tests to detect cancer regrowth. In the SANO trial, this included esophagogastroduodenoscopy (EGD) with biopsies, endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) of suspicious lymph nodes, and fluorodeoxyglucose positron emission tomography with computed tomography (PET-CT). The value of routine EUS in this setting remains largely unknown. This study aimed to assess the diagnostic yield of EUS over PET-CT.

Methods

A retrospective analysis of patients with esophageal cancer who underwent nCRT followed by clinical response evaluations with EGD, EUS, and PET-CT was performed. Initial response assessment was performed within 3 months post-nCRT. Patients without tumor regrowth underwent active surveillance with repeated diagnostic testing. The primary outcome was the rate of EUS-detected lymph node metastases missed by PET-CT, after excluding cases with positive EGD findings or distant metastases.

Results

327 patients underwent both PET-CT and EUS post-nCRT, accounting for 1006 combined procedures: 327 at initial response assessment; 679 during active surveillance (6–60 months post-nCRT) in 121 patients. Positive lymph nodes were detected by EUS in 3.7% (12/327) of initial response assessments, with 2.1% (7/327) unidentified by PET-CT. During surveillance, this dropped to 0.9% of assessments (6/679), with 0.1% (1/679) missed by PET-CT.

Conclusions

EUS with FNA adds most value at 3 months post-nCRT, when the likelihood of detecting recurrence is highest. Beyond 3 months, its added value is limited (0.1% with negative PET-CT). Restricting the use of EUS to PET-suspicious nodes could omit 98% of EUS procedures.

* Full study group membership is listed in Table 1s, see online-only Supplementary material.


Supplementary Material



Publication History

Received: 13 August 2025

Accepted after revision: 18 December 2025

Accepted Manuscript online:
21 December 2025

Article published online:
12 February 2026

© 2026. 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