Ultrasonic endoluminal examination in the follow-up of colorectal cancer. Initial experience and results.

We have been using endoluminal ultrasonography since 1988 as part of the follow-up procedure after colorectal surgery. A total of 106 patients with anterior resection of the rectum or the sigmoid colon were involved in 1988. The follow-up period for these patients ranged from 1 to 56 months after surgery (23.1 +/- 15.1 months after anterior resection of the rectum; 25.7 +/- 22 months after anterior resection of the sigmoid). During the observation period 7 patients developed recurrence after anterior resection of the rectum and 5 after anterior resection of the sigmoid. The primary stages for these patients had been 7 cases of Dukes' B, 3 of Dukes' C1 and 2 of Dukes' D. Raised serum CEA levels were found in 5 cases. In 3 other cases, we found pathological changes in the anastomotic region by means of endoscopy. In these the endorectal ultrasonic scan showed hypodense masses as a sign of recurrence. In 2 of these 3 cases, the serum CEA level was normal. In 4 cases endoluminal rectal ultrasonography alone was suspicious. This led to further diagnostic procedures and finally to radical excision. All suspicious ultrasonic images were monitored 2 to 4 weeks later. In cases of suspicion, endoscopic, needle or surgical transrectal biopsies were taken from all patients. In all cases, histological analysis confirmed the ultrasonic diagnosis of local recurrence.