Tang Y, Shi W, Sun X, Xi W
Department of Gastroenterology, The Third People's Hospital of Chengdu, Chengdu, China.
Dis Esophagus. 2017 Aug 1;30(8):1-6. doi: 10.1093/dote/dox031.
Definite diagnosis of esophageal tuberculosis (ET) requires isolation of tubercle bacilli, which is challenging in clinical practice. Difficulty in differentiating ET from other esophageal diseases may well result in a delay in diagnosis. The literature on utility of endoscopic ultrasound (EUS) in diagnosis of ET is insufficient. This study aims to evaluate the role of EUS morphology combined with EUS-guided tissue acquisition in the diagnosis of ET. Data of the 35 patients diagnosed with ET from January 2006 to October 2015 were retrospectively analyzed. After miniprobe and linear echoendoscopic visualization, either linear EUS-guided deep biopsy or EUS-guided fine needle aspiration was performed for tissue acquisition. Histocytopathological results showing caseous necrosis or acid fast bacilli (AFB) or epithelioid granuloma were considered diagnostic. Esophageal wall thickening or mass formation with disruption of the adventitia due to infiltration by adjacent mediastinal lymphadenopathy was typically observed under EUS. Tissue acquisition revealed epithelioid granuloma in 33 patients, caseous necrosis in 13, a positive AFB stain in 14, and nonspecific chronic inflammation in 2. Of the 35 patients, 33 (94.3%) with both characteristic EUS morphology and diagnostic histocytopathology were considered to have an EUS established diagnosis. The remaining two with only nonspecific chronic inflammation received empirical antitubercular chemotherapy based solely on EUS morphology. The two-year follow-up confirmed diagnosis of ET in all patients. While the final diagnosis of ET was based upon two-year follow-up of treatment response to antitubercular medication in addition to caseous necrosis/granuloma/positive-AFB stain revealed by EUS-guided tissue acquisition, an EUS-established diagnosis of ET and medical treatment with long-term follow-up is rational and practical compared with surgery or untreated follow-up.
食管结核（ET）的明确诊断需要分离出结核杆菌，这在临床实践中具有挑战性。难以将ET与其他食管疾病区分开来很可能导致诊断延迟。关于内镜超声（EUS）在ET诊断中的应用的文献并不充分。本研究旨在评估EUS形态学结合EUS引导下组织获取在ET诊断中的作用。对2006年1月至2015年10月期间诊断为ET的35例患者的数据进行回顾性分析。在微型探头和线性超声内镜观察后，进行线性EUS引导下深部活检或EUS引导下细针穿刺以获取组织。组织细胞病理学结果显示干酪样坏死、抗酸杆菌（AFB）阳性或上皮样肉芽肿被视为诊断依据。在EUS下通常观察到食管壁增厚或肿块形成，外膜因相邻纵隔淋巴结肿大浸润而破坏。组织获取显示33例患者有上皮样肉芽肿，13例有干酪样坏死，14例AFB染色阳性，2例有非特异性慢性炎症。在35例患者中，33例（94.3%）具有特征性EUS形态学和诊断性组织细胞病理学表现，被认为通过EUS确诊。其余2例仅有非特异性慢性炎症，仅根据EUS形态学接受经验性抗结核化疗。两年随访证实所有患者均为ET。虽然ET的最终诊断除了基于EUS引导下组织获取所显示的干酪样坏死/肉芽肿/AFB染色阳性外，还基于对抗结核药物治疗反应的两年随访，但与手术或未治疗随访相比，通过EUS确诊ET并进行长期随访的药物治疗是合理且实用的。
