Do we practice what we preach? clinical decision making and utilization of endoscopic ultrasound for staging esophageal cancer.

Abstract

Endosonography is accurate for staging esophageal cancer. However, whether detailed staging impacts clinical decision making, whether endosonography is perceived as a useful modality, and what factors influence the utilization of endosonography have not been studied. One hundred gastroenterologists were surveyed about staging and management of esophageal cancer, including: 1) management by stage; 2) perceived usefulness of endosonography; 3) availability of endosonography; and 4) number of patients referred. Clinical decisions varied by incremental differences in tumor stage. However, only 27 of 66 respondents (40.9%) judged endosonography to be very useful or essential for the evaluation of esophageal cancer and only 22 (33.3%) had referred a patient. Perceived usefulness and availability were independent factors strongly associated with referral for endosonography. Among 18 respondents to whom endosonography was available and who considered it useful, 14 (77.9%) had referred a case. In contrast, a conservative management was not associated with either perceived usefulness of or referral for endosonography. Clinicians recognize the importance of detailed staging for management of esophageal cancer. Despite this, they underestimate the utility of endosonography and fail to refer patients for appropriate evaluation. Lack of perceived usefulness and unavailability are important independent barriers to utilization of endosonography in clinical practice.