The factors influencing the accuracy of pre‐operative endoscopic ultrasonography assessment in endoscopic treatments for gastrointestinal tumors

BACKGROUND: This retrospective study aimed to evaluate the factors influencing the accuracy of Endoscopic Ultrasonography (EUS) as a preoperative assessment for gastrointestinal tumors. METHODS: A total of 261 patients with 264 gastrointestinal tumors were enrolled in the study. The parameters of the gastrointestinal lesions examined under EUS and their pathology were recorded and analyzed. RESULTS: The accuracy of EUS for detecting intramucosal lesions and subepithelial lesions (SELs) were 83.6% and 91.4%, respectively. One hundred and ninety‐four (73.5%) lesions originated from the mucous layer, as determined by pre‐operation EUS examinations. The accuracy of EUS in predicting the correct T stage for intramucosal lesions in the gastric region, esophagus, and colorectum was 77%, 71.8%, and 84.6%, respectively. According to the Paris endoscopic classification, the distribution of macroscopic patterns was different between the EUS‐pathology conformity and nonconformity groups (p = 0.018). In the nonconformity group, 48.6% of erosive lesions were classified as 0‐IIc, 0‐IIa + IIc, 0‐IIc + IIa or 0‐III macroscopic patterns compared with 26% patients in the conformity group (p = 0.025). Univariate analyses demonstrated that ulcerative lesions (OR = 7.516, 95% Confidence Interval [CI] 2.574–21.952, p < 0.001), location at the cardia of the stomach (OR = 3.619, 95%CI 1.076–12.168, p = 0.038), malignant tumor (OR = 2.920, 95%CI 1.339–6.368, p = 0.007) were significantly associated with EUS inaccuracy. Multivariate logistic regression analyses showed that ulcer was an independent risk factor associated with EUS inaccuracy, with odds ratios of 5.094 (95% CI: 1.641–15.807, p = 0.005). CONCLUSIONS: Our findings suggested that EUS is a reliable and easy‐to‐use diagnostic tool in decision‐making regarding appropriate endoscopic treatment for gastrointestinal tumors. However, the diagnostic accuracy of EUS appeared questionable in the presence of ulceration.