EUS in the diagnosis of pathologically undiagnosed esophageal tuberculosis

Esophageal tuberculosis

Esophageal tuberculosis (ET) is an extremely rare disease and herein, we present an ET case. Endoscopic findings of ET are variable and diverse and can be easily mistaken for malignancy. A definitive diagnosis of ET is difficult to make with white light endoscopy alone, and the diagnostic yield of a biopsy is low in secondary ET cases with normal overlying mucosa. Although the findings of conventional endoscopy and endoscopic ultrasonography in ET have been reported so far, few reports have described the findings of magnifying endoscopy with narrow-band imaging (ME-NBI). Dilated microvessels without irregularities on ME-NBI may be useful to differentiate secondary ET from esophageal carcinoma, since the findings suggest compression from the depth. Although rare, ET has to be considered in the differential diagnosis for any unexplained esophageal lesions.

Primary oesophageal tuberculosis presenting with dysphagia: A rare scenario

Dysphagia is a clinical manifestation with great consequences. Prompt and early diagnosis is the key to long-term management. Despite tuberculosis (TB) being common in developing countries, primary oesophageal TB is still a very rare disease. Oesophageal manifestations are almost exclusively a result of direct extension from adjacent mediastinal structures. We report a case of an immune-competent man presenting with dysphagia due to primary oesophageal TB.

Role of Endoscopy in Esophageal Tuberculosis: A Narrative Review

Esophageal tuberculosis (ET) is a rare infectious disease of the gastrointestinal tract. Awareness of ET is deficient due to its low incidence. Unexplained dysphagia and upper gastrointestinal bleeding are the most common symptoms of ET. The prognosis is generally good if patients are diagnosed properly and receive anti-tubercular treatment promptly. However, ET is difficult to differentiate from other diseases. Endoscopic techniques such as esophagogastroduodenoscopy (EGD), endoscopic ultrasonography (EUS), contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS), elastography, and endoscopic ultrasound--guided fine-needle aspiration (EUS-FNA) improve the diagnosis of ET. Thus, the characteristics of ET and other difficult-to-detect diseases according to EGD and EUS were summarized. Intriguingly, there is no literature relevant to the application of CH-EUS and elastography in ET. The authors' research center was first in introducing CH-EUS and elastography into the field of ET. The specific manifestation of ET based on CH-EUS was discovered for the first time. Correlative experience and representative cases were shared. The role of endoscopy in acquiring esophageal specimens and treatment for ET was also established. In this review, we aim to introduce a promising technology for the diagnosis and treatment of ET.

Current role of endoscopic ultrasound for gastrointestinal and abdominal tuberculosis

A high incidence of tuberculosis (TB), especially in endemic countries, makes this infectious disease a concern. Abdominal TB contributes to 10% of extrapulmonary TB. Due to nonspecific clinical, radiological, and endoscopic findings, diagnosing abdominal TB continues to be a challenge. Hence, a precise diagnosis is needed. The diagnosis of gastrointestinal disease using endoscopic ultrasound (EUS) is often performed due to its high resolution and ability to provide a real‐time visual representation of the gastrointestinal tract and extramural structures. EUS‐guided fine‐needle aspiration (FNA) and fine‐needle biopsy (FNB) have helped diagnose TB as they offer an adequate specimen for cytology or histopathological examination. This method is considered safer, more effective, and more efficient. The capacity of EUS to diagnose abdominal TB based on the affected organs was examined via a literature search. We reviewed the role of EUS in diagnosing esophageal, gastric, pancreatic, peripancreatic, hepatosplenic, peritoneal, and intestinal TB. Generally, EUS aids in diagnosing abdominal TB. In some organs, it is superior to other diagnostic modalities. However, further examinations, such as cytology or histopathology and microbial, are still needed. We also studied the roles of EUS‐FNA and EUS‐FNB. EUS‐FNA has shown a high diagnostic yield in esophageal (94.3–100%), pancreatic and peripancreatic (76.2%), and intestinal TB (84.1%). As minimally invasive methods, EUS‐FNA and EUS‐FNB can successfully provide sufficient samples. EUS is a functional diagnostic modality for abdominal TB. EUS‐FNA and EUS‐FNB provide sufficient samples safely and efficiently for further cytology, histopathology, and microbial examinations.

Isolated esophageal tuberculosis: A case report

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.

Oesophageal Tuberculosis: A Systematic Review Focusing on Clinical Management

Oesophageal tuberculosis, an uncommon form of extrapulmonary tuberculosis, has been reported mainly as small case series and the literature is heterogeneous. A systematic review to characterize the clinical presentation, evaluation and management of oesophageal tuberculosis was performed. Electronic databases were searched with keywords: esophagus OR esophageal AND tuberculosis. We included original papers and case series (> 4 patients) with oesophageal tuberculosis. Twenty-two studies reporting 311 patients were included. Mean age in most of the studies was 31-51 years and male gender constituted 50.5% patients. Dysphagia (72.3%), odynophagia (22.4%) and chest pain (31.3%) were predominant symptoms. Mid-oesophagus was the commonest site of involvement (88%). Endoscopic findings included ulcers (59.9%), submucosal bulge (31.7%), extrinsic compression (24.8%) and pseudotumour (5.8%). On endoscopic ultrasound, presence of hypoechoic (69.5%), heteroechoic (47.6%) and matted (86.3%) mediastinal lymph nodes and oesophageal wall involvement (67.3%) were common findings. Computed tomography showed mediastinal lymphadenopathy (76.5%) and oesophageal thickening (52.1%). Diagnosis was confirmed by granuloma (72.3%) and acid fast bacilli positivity (32.5%) in mots patients. Response to antitubercular therapy was excellent; 97.7% patients recovered and 2.3% patients died. Surgery (14.5%) and oesophageal stenting (11.4%) were required infrequently. Oesophageal tuberculosis should be considered in endemic regions as a cause of dysphagia because early treatment is associated with excellent outcomes.