# Endoscopic Ultrasound in Squamous Cell Esophageal Cancer: From Staging to Strategy—A Narrative Review

## TL;DR

This review discusses how endoscopic ultrasound (EUS) is used to stage and manage squamous cell esophageal cancer, highlighting its role alongside other diagnostic tools and new treatment approaches.

## Contribution

The paper provides a comprehensive narrative review on the evolving role of EUS in ESCC management, emphasizing multimodal approaches and emerging techniques.

## Key findings

- EUS is the preferred modality for staging esophageal squamous cell carcinoma due to its accuracy in assessing tumor depth and lymph node involvement.
- Combining EUS with CT, PET, and histologic sampling improves diagnostic precision in ESCC.
- Emerging EUS techniques like contrast-enhanced imaging and elastography may enhance clinical outcomes.

## Abstract

Esophageal squamous cell carcinoma (ESCC) remains a major global health challenge due to its aggressive nature and frequent late-stage diagnosis. Accurate locoregional staging is critical for guiding appropriate therapy, and endoscopic ultrasound (EUS) has emerged as the preferred modality for assessing tumor depth and regional lymph node involvement. In this narrative review, we provide a comprehensive overview of the role of EUS in the management of ESCC, from initial staging to post-treatment assessment. We discuss its strengths and limitations, particularly in differentiating early-stage disease and in restaging after neoadjuvant therapy. The importance of a multimodal approach—integrating EUS with computed tomography (CT), positron emission tomography (PET), and histologic sampling—is emphasized to improve diagnostic precision. We also explore emerging techniques, such as contrast-enhanced EUS, elastography, and novel therapeutic strategies including immune checkpoint inhibitors and endoscopic mucosal resurfacing. While EUS remains a cornerstone in the management of ESCC, ongoing innovation and integration with personalized medicine are expected to further enhance its clinical impact.