Diagnostic accuracy of 1,000 endorectal ultrasounds before transanal endoscopic microsurgery for rectal neoplastic lesions

EUS before TEM shows good overall accuracy and excellent reliability for excluding deep invasion, with progressive improvement over the past 3 decades. While overstaging remains a limitation in post-treatment and non-dysplastic lesions, EUS continues to play a pivotal role in selecting candidates for organ-preserving rectal surgery. In post-endoscopic resection scars and post-neoadjuvant rectum, EUS findings should be interpreted cautiously and integrated with MRI/endoscopic morphology.