Endosonographic features of esophageal tuberculosis presenting as a subepithelial lesion

Seo, Jong Hun; Kim, Gwang Ha; Jhi, Joon Hyung; Park, Young Joo; Jang, Yae Su; Lee, Bong Eun; Song, Geun Am

doi:10.1111/1751-2980.12454

Cited by 8 publications

(7 citation statements)

References 8 publications

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“…The esophagus can be affected throughout its length, although the lesion is most often located in the middle third[ 3 , 7 , 8 ], because of the extensive lymphoid tissue in this region. Endoscopy may show an ulcer of variable size, superficial with regular contours or irregular and infiltrative simulating neoplasia, or show a more or less ulcerated budding aspect of the mucosa[ 3 , 9 ]. An extrinsic compression aspect with a mucosa of normal appearance can also be found[ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Isolated esophageal tuberculosis: A case report

Diallo¹,

Touré²,

Sarr³

et al. 2022

WJGE

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BACKGROUND Tuberculosis is endemic in Senegal. While its extra-pulmonary localization is rare, esophageal tuberculosis, particularly the isolated form, is exceptional. We report here a case of isolated esophageal tuberculosis in an immunocompetent patient. CASE SUMMARY A 58-year-old man underwent consultation for mechanical dysphagia that had developed over 3 mo with non-quantified weight loss, anorexia, and fever. Upper digestive endoscopy showed extensive ulcerated lesions, suggesting neoplasia. The diagnosis was confirmed by histopathology, which showed gigantocellular epithelioid granuloma surrounding a caseous necrosis. Thoracoabdominal computed tomography scan did not show another localization of the tuberculosis. The outcome was favorable with treatment. CONCLUSION Esophageal tuberculosis should be considered when dysphagia is associated with atypical ulcerated lesions of the esophageal mucosa, in an endemic area.

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Section: Discussionmentioning

confidence: 99%

Isolated esophageal tuberculosis: A case report

Diallo¹,

Touré²,

Sarr³

et al. 2022

WJGE

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“…Some patients may have a history of tuberculosis in other parts of the body (mostly pulmonary tuberculosis). PPD test or T-SPOT.TB, ESR, chest CT, and esophagography may have certain reference value in the diagnosis of ET [ 19 ]. Esophageoscopic findings lack specificity, and pathological biopsies are sometimes disappointing; false-negative results often occur due to the failure to obtain definite caseous necrotizing granuloma and acid-fast bacilli.…”

Section: Discussionmentioning

confidence: 99%

“…For pathologically undiagnosed ET, EUS has the advantage of combining ultrasonography with endoscopy and can show some features of ET. Although biopsies (including EUS-FNA) are sometimes negative, we can first consider the diagnosis of ET based on EUS examination, and exclude tumours though pathology; when EUS features are combined with clinical features, we can consider experimental anti-tuberculosis treatment [ 19 ] for ET patients and finally make a definite diagnosis according to treatment effect. In addition, when EUS is used as the initial examination for patients, the characteristics summarized in this paper can be sufficient to help establish our initial diagnosis.…”

Section: Discussionmentioning

confidence: 99%

EUS in the diagnosis of pathologically undiagnosed esophageal tuberculosis

et al. 2020

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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.

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“…Por lo general, ocurre como resultado de la diseminación directa desde los ganglios mediastínicos (rara vez desde los pulmones o el torrente sanguíneo) (6). La afectación primaria de la tuberculosis en el esófago no es común debido a mecanismos protectores tales como el epitelio escamoso estratificado de múltiples capas, la mucosidad, la saliva, el peristaltismo y la postura erecta, lo que hace que la bacteria permanezca en el esófago solo de forma transitoria (7). La tuberculosis esofágica no tiene características clínicas, de laboratorio, radiológicas o endoscópicas.…”

Section: Introductionunclassified

Tuberculosis esofágica asociada con inmunosupresión por VIH: reporte de caso

Ortiz¹,

Mesa²,

Acosta³

et al. 2021

Rev colomb Gastroenterol

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Introducción: la tuberculosis es una enfermedad infecciosa que suele afectar a los pulmones y es causada por Mycobacterium tuberculosis. Se transmite de una persona a otra a través de gotículas generadas en el sistema respiratorio de pacientes con enfermedad pulmonar activa. La tuberculosis esofágica es una afección rara (representa solo el 2,8 % de todos los casos de tuberculosis gastrointestinal). Por lo general, ocurre como resultado de la diseminación directa desde los ganglios mediastínicos (rara vez desde los pulmones o el torrente sanguíneo). Su diagnóstico definitivo requiere el aislamiento de los bacilos tuberculosos, lo que rara vez se logra en la práctica clínica; aun así, clínicamente los pacientes presentan síntomas de disfagia, odinofagia y adelgazamiento. Caso clínico: se presenta un paciente de 40 años de edad con cuadro clínico de 6 meses de evolución con disfagia progresiva exacerbada a disfagia para líquidos, astenia, adinamia, hiporexia, dolor pleurítico, epigastralgia y tos con expectoración blanquecina; se realizó una endoscopia de vías digestivas altas que mostró una mucosa gravemente inflamada con ulceraciones irregulares de hasta 2 cm de profundidad, lesiones que sugirieron tuberculosis esofágica, confirmada por el estudio histopatológico: esofagitis crónica granulomatosa; por tanto, se inició el tratamiento tetraconjugado: rifampicina, isoniazida, pirazinamida y etambutol. Conclusiones: La tuberculosis con afección del tubo digestivo es una entidad de baja frecuencia; adicionalmente, es importante recordar que la gravedad del cuadro clínico usualmente está relacionada con la coinfección por el virus de la inmunodeficiencia humana (VIH), y que la asociación de ambas patologías es frecuente.

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Endosonographic features of esophageal tuberculosis presenting as a subepithelial lesion

Cited by 8 publications

References 8 publications

Isolated esophageal tuberculosis: A case report

Isolated esophageal tuberculosis: A case report

EUS in the diagnosis of pathologically undiagnosed esophageal tuberculosis

Tuberculosis esofágica asociada con inmunosupresión por VIH: reporte de caso

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