Schistosomiasis enteropathy diagnosed by real-time endocytoscopy.

Abstract

Fourth-generation endocytoscopy (EC) integrates a variable-focus lens and provides up to 520× continuous zoom-focus magnification. A single endoscope enables white-light imaging, narrow-band imaging, and cellular-level observation. The so-called virtual histology or optical biopsy has shown promising diagnostic ability in GI malignancies or premalignant lesions. Here, we report unexpected findings in the diagnosis of a rare benign disease. A 43-year-old man without a significant medical history underwent a colonoscopy because of abdominal distension. The colonoscopy showed patchy areas of multifocal white miliary spots in the hyperemic mucosa of the descending colon, with no features of polypoid tissue (A). Endocytoscopic ultramagnified images were obtained after staining with 1% methylene blue and 0.05% crystal violet. The microsurface structure of the gland was obviously destroyed, and a large number of seedlike oval structures were notable under endocytoscopy (CF-H290ECI endocytoscope; Olympus, Tokyo, Japan) (B). The on-site pathologist confirmed these structures to be schistosome eggs. Histologic examination of the targeted biopsy specimen also revealed numerous eggs of schistosome organisms (C, H&E, orig. mag. ×200). We hope that this first reported endocytoscopic observation of schistosomiasis enteropathy may enrich the understanding and application of this novel technique, and we believe that maximum diagnostic yield can be achieved under the guidance of an on-site pathologist, although a trained endoscopist can make the diagnosis in most cases.