EUS in the diagnosis of pathologically undiagnosed esophageal tuberculosis
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RESEARCH ARTICLE
Open Access
EUS in the diagnosis of pathologically undiagnosed esophageal tuberculosis Rong Zhu1, Yonghua Bai2, Yuankun Zhou1, Xingguo Fang1, Kui Zhao1, Biguang Tuo1 and Huichao Wu1*
Abstract Background: 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. Methods: We 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)). Results: Nine 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. Conclusions: EUS 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. Keywords: Esophageal tuberculosis (ET), Endoscopic ultrasonography (EUS), Retrosternal pain, Dysphagia
Background Esophageal tuberculosis (ET) is relatively rare, accounting for < 0.2% of all tuberculosis (TB) patients [1–3]. The clinical manifestations are often not specific, including mucosal or submucosal eminence lesions, ulcer, fistula [4], and others [5]. A definite diagnosis of ET requires finding acid-fast bacilli or caseous necrotizing granuloma * Correspondence: [email protected] 1 Department of Gastroenterology, Affiliated Hospital, Zunyi Medical University, Zunyi 563003, China Full list of author information is available at the end of the article
[6], which is challenging in clinical practice. Therefore, patients with ET are often misdiagnosed or receive a delayed diagnosis. Endoscopic ultrasonography (EUS) can show the sha
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