Observation of bilobed nucleus sign by endocytoscopy in eosinophilic esophagitis

Abstract

A 55-year-old man was referred for the endoscopic assessment of heartburn and dysphagia. The symptoms were refractory to proton pump inhibitors. EGD revealed esophageal rings, linear furrows, and mucosal fragility in the upper and mid esophagus (A). Subsequently, we performed endocytoscopy (GIF-H290EC; Olympus Corp, Tokyo, Japan), which allows magnification up to ×520. The esophagus was washed sufficiently with water, followed by spraying crystal violet and methylene blue (CM double-staining technique: mixture of 0.05% crystal violet and 0.1% methylene blue) to obtain images similar to those produced by hematoxylin and eosin staining.