The aim of this prospective, blinded study of patients with rectal cancer, was to assess the impact of preoperative staging on treatment decisions and compare the tumor (T) and nodal (N) staging performance characteristics of pelvic computed tomography (CT), rectal endoscopic ultrasonography (EUS), and EUS FNA. The authors concluded that preoperative staging with EUS results in more frequent use of preoperative neoadjuvant therapy than if staging was performed with CT alone. The addition of FNA only changed the management of one patient, whereas FNA did not significantly improve N staging accuracy over EUS alone. FNA seems to offer the most potential for impacting management in those patients with early T stage disease, and its use should be confined to this subgroup of patients. EUS is more accurate than CT for determining T stage of rectal carcinoma.

This study is a good case in point that every lymph node or mass lesion seen by EUS that could potentially be subjected to EUS guided FNA should not be punctured, but rather a decision should be made on a case to case basis based on the potential clinical impact of the EUS guide FNA.

The purposes of this study were to develop a noninvasive method for measuring intravariceal pressure, and to develop a model of esophageal varices that can be used to test this pressure measurement device. The authors concluded that the variceal pressure measuring device developed for this study measured intravariceal pressure in a model varix with a low percent error and high correlation to the actual pressures. Intraobserver and interobserver variability was low.

This study validates in a variceal model the ability of a modified EUS miniprobe to measure pressure in esophageal varices. Since EUS is now established as a method of imaging, EUS guided FNA with ability to get a tissue diagnosis, EUS may also be a useful in the future for physiological measurements such as variceal pressure measurement in a minimally invasive way. The results from this group are very promising and further research in this area would be beneficial.

These are helpful guidelines from the ASGE on quality assessment of endoscopic ultrasound based on the studies published so far related to this issue in EUS. All current and aspiring endosonographers would benefit by reading this article.