Narrow-band imaging magnifying endoscopy in adult patients with eosinophilic esophagitis/esophageal eosinophilia and lymphocytic esophagitis

Tanaka, Kyosuke; Rubio, Carlos A.; Dlugosz, Aldona; Truskaite, Kotryna; Befrits, Ragnar; Lindberg, Greger; Schmidt, Peter T.

doi:10.1016/j.gie.2013.05.025

Cited by 33 publications

(31 citation statements)

References 16 publications

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“…According to a recent meta-analysis, prospective studies showed that at least 1 abnormality was detected by endoscopy in 93% of EoE patients [25]. Therefore, endoscopic findings suspicious of EE, especially linear furrows, can be detected in most patients with EE by an experienced endoscopist with careful observation using a high-resolution or narrow-band imaging endoscopy [32]. …”

Section: Discussionmentioning

confidence: 99%

Reliability of Symptoms and Endoscopic Findings for Diagnosis of Esophageal Eosinophilia in a Japanese Population

Shimura¹,

Ishimura²,

Tanimura

et al. 2014

Digestion

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Background/Aims: The clinical characteristics of esophageal eosinophilia (EE), which is essential for diagnosis of eosinophilic esophagitis (EoE), have not been fully clarified in a Japanese population. The aim of this study was to analyze the reliability of symptoms and endoscopic findings for diagnosing EE in Japanese individuals. Methods: We prospectively enrolled subjects who complained of esophageal symptoms suggesting EoE and/or those with endoscopic findings of suspected EoE at the outpatient clinics of 12 hospitals. Diagnostic utility was compared between the EE and non-EE groups using logistic regression analysis. Results: A total of 349 patients, including 319 with symptoms and 30 with no symptoms but endoscopic findings suggesting EoE were enrolled. Of those with symptoms, 8 (2.5%) had EE, and 3 were finally diagnosed with EoE. Of those without symptoms but endoscopic findings, 4 had EE. Among 8 symptomatic patients, 7 had abnormal endoscopic findings suspicious of EoE. Although dysphagia was a major symptom in EE, none of the presenting symptoms was useful for diagnosis of EE. Among the endoscopic findings, linear furrow was the most reliable (OR = 41.583). Conclusion: EE is uncommon among patients with esophageal symptoms in Japanese individuals. The most useful endoscopic finding for diagnosis of EE was linear furrow, whereas subjective symptoms were not supportive.

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Section: Discussionmentioning

confidence: 99%

Reliability of Symptoms and Endoscopic Findings for Diagnosis of Esophageal Eosinophilia in a Japanese Population

Shimura¹,

Ishimura²,

Tanimura

et al. 2014

Digestion

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“…The endoscopic findings in LyE have been described in only a few reports and they can often mimics EoE[1,5,14,15]. Features include esophageal rings, linear furrows, whitish exudates, and esophageal strictures/stenosis (Figure 3).…”

Section: Discussionmentioning

confidence: 99%

“…Attempts have been made to characterise the endoscopic features of both LyE and EoE using narrow band imaging magnifying endoscopy (NBI-ME). In the study by Tanaka et al[14], three features were identified on NBI-ME in their cohort of 21 patients (11 patients with LyE, 10 patients with EoE): (1) beige coloured mucosa (normal mucosa has light green colour); (2) increased and dot-shaped congested intrapapillary capillary loop; and (3) invisibility of submucosal vessels (normal mucosa has cyna-coloured vessels). In the LyE group, at least one of the above finding was evident in 91% (10/11) of patients, and all three findings were present in 82% (9/11) of patients.…”

Section: Discussionmentioning

confidence: 99%

Lymphocytic esophagitis: Report of three cases and review of the literature

Jideh¹,

Keegan²,

Weltman³

2016

WJCC

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Lymphocytic esophagitis (LyE) is a rare condition characterised histologically by high numbers of esophageal intraepithelial lymphocytes without significant granulocytes infiltration, in addition to intercellular edema (“spongiosis”). The clinical significance and natural history of LyE is poorly defined although dysphagia is reportedly the most common symptom. Endoscopic features range from normal appearing esophageal mucosa to features similar to those seen in eosinophilic esophagitis, including esophageal rings, linear furrows, whitish exudates, and esophageal strictures/stenosis. Symptomatic gastroesophageal reflux disease is an inconsistent association. LyE has been associated in paediatric Crohn’s disease, and recently in primary esophageal dysmotility disorder in adults. There are no studies assessing effective treatment strategies for LyE; empirical therapies have included use of proton pump inhibitor and corticosteroids. Esophageal dilatation have been used to manage esophageal strictures. LyE has been reported to run a benign course; however there has been a case of esophageal perforation associated with LyE. Here, we describe the clinical, endoscopic and histopathological features of three patients with lymphocytic esophagitis along with a review of the current literature.

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“…Endoscopic findings may be very subtle, however, and biopsies may never be taken. Two recent studies have suggested increasing diagnostic yield as well as recognition of novel features of EoE using optical enhancement endoscopy and biopsy such as Narrow Band Imaging (NBI) 13 14 . Therefore, in our routine standard practice, we have adopted use of HD and virtual chromoendoscopy to better detect, characterize and enhance endoscopic findings of EoE and take additional biopsies from the furrows.…”

Section: Introductionmentioning

confidence: 99%

High-definition-iSCAN virtual chromoendoscopy has high sensitivity and specificity for the diagnosis of eosinophilic esophagitis

et al. 2017

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Background and study aims A major challenge in eosinophilic esophagitis (EoE) is disease recognition during endoscopy as there are no pathognomonic findings. We aimed to determine the utility of high-definition (HD) iSCAN virtual chromoendoscopy (VC) in diagnosis of EoE. Patients and methods One hundred eighty-nine consecutive patients presenting with dysphagia or food bolus impaction were assessed using HD-iSCAN VC (Pentax, Japan) with biopsies from distal, mid, upper esophagus and from furrows where visible. Results Of 189 patients, 45 (23.8 %, male = 29, median age 40y) had a histological diagnosis of EoE; 73.3 % of the patients were newly diagnosed. iSCAN endoscopic features of EoE were linear furrows (91 %), edema (77.8 %), rings or tracheal appearance (73.3 %), whitish exudates (26.6 %) and narrowing or stricture (5 %). One patient (2.2 %) had all 5 endoscopic features. Ten patients (22.2 %) had linear furrows, edema,rings or tracheal appearance and whitish exudates on iSCAN, with a positive predictive value (PPV) 100 % (95 % CI 69.1 %-100 %) and negative predictive value (NPV) 80.4 % (95 % CI 73.9 %-86 %). Thirteen patients (29 %) presented with linear furrows, edema and rings or tracheal appearance on iSCAN, with a PPV 100 % (95 % CI 75.3 %-100 %) and NPV 81.8 % (95 % CI 75.3 %-87.2 %). Six patients (13.3 %) had furrows and edema and 6 patients (13.3 %) had furrows and rings or tracheal appearance on iSCAN, with a PPV 100 % (95 % CI 54.1 %-100 %) and NPV 78.69 % (95 % CI 72 %-84.4 %), respectively. The sensitivity and specificity of HD-iSCAN endoscopy were 97.62 % (95 % CI 87.43 %-99.94 %) and 89.58 % (95 % CI 83.40 %-94.05 %). The accuracy of HD-iSCAN endoscopy was 92.47 % (95 % CI 87.67 %-95.56 %). Conclusion HD-iSCAN endoscopy is sensitive and specific with good accuracy for EoE diagnosis. Linear furrows, edema and tracheal appearance were the most common findings and these 3 endoscopic features had a high predictive value for diagnosis of EoE.

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Narrow-band imaging magnifying endoscopy in adult patients with eosinophilic esophagitis/esophageal eosinophilia and lymphocytic esophagitis

Cited by 33 publications

References 16 publications

Reliability of Symptoms and Endoscopic Findings for Diagnosis of Esophageal Eosinophilia in a Japanese Population

Reliability of Symptoms and Endoscopic Findings for Diagnosis of Esophageal Eosinophilia in a Japanese Population

Lymphocytic esophagitis: Report of three cases and review of the literature

High-definition-iSCAN virtual chromoendoscopy has high sensitivity and specificity for the diagnosis of eosinophilic esophagitis

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