Endoscopic ultrasound in diagnosis of esophageal tuberculosis: 10-year experience at a tertiary care center
Endoscopic ultrasound in diagnosis of esophageal tuberculosis: 10-year experience at a tertiary care center
复制标题
DOI：
10.1093/dote/dox031
复制
发表时间：
2017-08-01
影响因子：
2.6
通讯作者：
Xi, W.
中科院分区：
文献类型：
--
作者：
Tang, Y.;Shi, W.;Xi, W.
食管结核（ET）的确诊需要分离结核杆菌，这在临床实践中具有挑战性。难以区分 ET 与其他食管疾病很可能会导致诊断延迟。关于超声内镜 (EUS) 在诊断 ET 中的应用的文献并不充分。本研究旨在评估 EUS 形态学联合 EUS 引导组织采集在 ET 诊断中的作用。回顾性分析2006年1月至2015年10月诊断为ET的35例患者的资料。在微型探针和线性回声内窥镜可视化之后，进行线性 EUS 引导的深部活检或 EUS 引导的细针抽吸来采集组织。组织细胞病理学结果显示干酪样坏死或抗酸杆菌（AFB）或上皮样肉芽肿被认为具有诊断意义。在 EUS 下通常会观察到由于邻近纵隔淋巴结肿大的浸润导致食管壁增厚或肿块形成，并伴有外膜破坏。组织采集显示 33 名患者出现上皮样肉芽肿，13 名患者出现干酪样坏死，14 名患者出现 AFB 染色阳性，2 名患者出现非特异性慢性炎症。在 35 名患者中，33 名 (94.3%) 具有特征性 EUS 形态和诊断性组织细胞病理学，被认为具有 EUS 确诊。其余两名仅患有非特异性慢性炎症的患者仅根据 EUS 形态接受了经验性抗结核化疗。两年的随访证实所有患者均诊断为 ET。虽然 ET 的最终诊断是基于抗结核药物治疗反应的两年随访，以及 EUS 引导组织采集显示的干酪样坏死/肉芽肿/AFB 染色阳性，但与手术或未经治疗的随访相比，EUS 确定的 ET 诊断和长期随访的药物治疗是合理且实用的。
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.