Abstract
BackgroundEsophageal tuberculosis (ET) is relatively rare, and the diagnosis is challenging. The aim of this study was to evaluate the clinical features of ET and highlight the role of endoscopic ultrasonography (EUS) in the diagnosis of pathologically undiagnosed ET.MethodsWe retrospectively analysed the clinical features, radiological performances, conventional endoscopic appearances, EUS features, treatment and outcomes of pathologically undiagnosed ET between January 2011 and December 2018. All 9 patients failed to be diagnosed by at least two repeated biopsies (such as routine biopsy, multipoint or deep biopsy, and even or EUS-guided fine-needle aspiration (EUS-FNA)).ResultsNine patients (66.7% female) with a mean age of 45 years (range 29–59) complained of retrosternal pain or discomfort, or (and) dysphagia. Esophagoscopy demonstrated protruding lesions in the mucosa with central ulcers or erosion in five patients, submucosal bulges with smooth surfaces in one patient, submucosal bulges with diverticula in one patient, ulcers with suspicious fistula formation in one patient, and multiple ulcers in one patient. None of the patients received confirmed histopathological or bacteriological diagnoses by repeated biopsies. However, they were first suspected to have ET based on EUS examination. Because EUS found some characteristic ultrasonographic changes, which were very helpful for the diagnosis of ET when combined with clinical manifestations, the patients subsequently received diagnostic antituberculosis therapy. Finally, the patients recovered or improved with follow-up times ranging from 3 to 10 months.ConclusionsEUS could help in the diagnosis of ET on basis of EUS features like poorly defined esophageal wall structure, enlarged paraesophageal or mediastinal lymph nodes, hypoechoic lesions of esophageal wall that are linked to the enlarged paraesophageal lymph nodes. However all attempts should be made to obtain histological or microbiological diagnosis.
Highlights
Esophageal tuberculosis (ET) is relatively rare, and the diagnosis is challenging
All 9 patients were first suspected to have ET based on Endoscopic ultrasonography (EUS) examination, and when combined with the clinical manifestations, the patients all received diagnostic antituberculosis therapy
Eight cases were confirmed by repeated biopsies (3 cases with routine biopsy and deep excavation, 4 cases with routine biopsy and multipoint biopsy, and one case with routine biopsy and EUSFNA), but the pathological findings were only chronic or acute inflammation, and no specific caseous necrotizing granuloma or acid-fast staining positive bacilli was found. (Table 1)
Summary
Esophageal tuberculosis (ET) is relatively rare, and the diagnosis is challenging. The aim of this study was to evaluate the clinical features of ET and highlight the role of endoscopic ultrasonography (EUS) in the diagnosis of pathologically undiagnosed ET. Esophageal tuberculosis (ET) is relatively rare, accounting for < 0.2% of all tuberculosis (TB) patients [1,2,3]. A definite diagnosis of ET requires finding acid-fast bacilli or caseous necrotizing granuloma [6], which is challenging in clinical practice. Endoscopic ultrasonography (EUS) can show the shape and echogenicity features of the lesion, its relationship with the esophageal wall, the esophageal wall and extramural changes, such as extramural lymph nodes, and EUS may provide a cytological and pathological diagnosis by endoscopic ultrasonographyguided fine-needle aspiration (EUS-FNA) [7], or exclude lesions such as cancer. EUS has unique value in the diagnosis and differential diagnosis of ET, especially
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
