I think (but might very well be wrong here, maybe someone else will jump in) that the endoscopy and endoscopic ultrasound are how they staged Jeff initially, He had the CT scan first, they saw the mass and then did the endo and EUS. The PET scan in 2018 lit up in the esophagus and nearby lymph nodes only, (thought to be stage 3 then), but the laparoscopy and washings they did while putting the feeding tube in showed the spread. He was deemed stage 4.
He didn't want the feeding tube either. When his weight dropped below 110, he finally agreed. I think it helped save him at that time. He had it for 8-12 months if I remember correctly.
This time, he was strongly against the feeding tube, pretty much refused it. We used Ensure Plus as a supplement, a lot of it. He got through without the G-tube thankfully. It's not a risk to take though (in my opinion...) because the weight loss will happen fast and furious.
I will send you a PM if you want to talk. This is not easy to navigate. Hang in there. ❤️
Lynn