De même, le diagnostic de récidive locale par les mêmes méthodes est bien souvent tardif et les chances de réintervention pas dérection après une chirurgie rectale visée curative sont très minces. Diverses modifications peuvent être mises en évidence dans la région anastomotique mais seule une image nodulaire hypoéchogène — dans la sous-muqueuse ou la muscularis propria — a une valeur diagnostique.
Summary Preoperative staging of rectal carcinoma by endoscopy, conventional radiology or CT scan is usually very disappointing for both depth of the infiltration into the rectal wall or perirectal tissues and in detection of parietal lymph nodes.
In the same way, local recurrences are diagnosed too late by the same methods and chances for curative reintervention are very low.
The aim of this study is to evaluate the clinical value of EUS in early diagnosis of local recurrence. We performed EUS examination of the rectal suture and 10 cm above and below, every 6 months.
In the post-operative follow-up group of 81 patients 23 cases of recurrence were suspected by EUS, — 14 underwent second look surgery, with confirmation of the diagnosis in all of them only 5 of 14 were positive at endoscopic biopsy— 7 patients did not undergo for second look surgery — 1 had no evidence of recurrence 20 months after EUS. Various abnormalities can be observed in the suture area but only hypoechoic nodule -usually in the submucosa or muscularis propria — is of diagnostic value.
Our results show that EUS is one of the best procedures currently available for assessing parietal involvement and staging of rectal carcinoma.
EUS might be able to guide therapeutical options. EUS is a sensitive method to early diagnose local recurrence and lets the surgeon the opportunity for a second surgical — maybe curative — resection.
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