Clinical decisions varied by incremental differences in tumor stage. However, only 27 of 66 respondents (40.9%) judged endosonography to be very useful or essential for the evaluation of esophageal cancer and only 22 (33.3%) had referred a patient. Perceived usefulness and availability were independent factors strongly associated with referral for endosonography. Among 18 respondents to whom endosonography was available and who considered it useful, 14 (77.9%) had referred a case