The great transformation in the management of rectal cancer has increased the importance of accurate pre-operative staging in decision-making. Depth of penetration and nodal status in rectal neoplasms guide therapeutic decisions to perform local excision or transanal endoscopic microsurgical excision, to take the patient directly for radical surgery or to offer neoadjuvant chemoradiotherapy. Of the available technologies, namely computed tomography (CT), magnetic resonance imaging (MRI), endoluminal coil MRI and endorectal ultrasound (ERUS), the latter has evolved as the best modality for accurately staging rectal cancer. ERUS has many advantages over CT and MRI. First the ERUS probe is placed in close proximity to the area of interest and the resolution and imaging quality are thus greatly enhanced. Second, it is an office-based procedure of short duration and is well tolerated by patients. Third, it is relatively low cost.
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