Clinical and endoscopic features of esophageal tuberculosis: a 20-year retrospective study
Clinical and endoscopic features of esophageal tuberculosis: a 20-year retrospective study
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食管结核的临床和内镜特征：20年回顾性研究
DOI：
10.1080/00365521.2020.1813799
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发表时间：
2020-09-02
影响因子：
1.9
通讯作者：
Liu, Side
中科院分区：
文献类型：
--
作者：
Xiong, Jing;Guo, Wen;Liu, Side
背景食管结核是一种罕见的临床实体。关于食管结核的数据很少。本研究旨在分析近20年来食管结核的临床和内镜特征。方法回顾性分析1999年1月至2019年1月南方医院收治的14例食管结核患者的临床资料。如果组织病理学结果显示上皮样肉芽肿伴或不伴干酪样坏死，则认为结核病诊断。记录临床特征、影像学表现、内镜特征和抗结核治疗结果。结果14例确诊为食管结核的患者均行食管镜检查。吞咽困难7例（50%），胸骨后疼痛6例（42.86%），咳嗽1例（7.14%）。内镜下可见食管中段病变，其中隆起性病变10例（71.43%），溃疡3例（21.43%），气管食管瘘1例（7.14%）。内镜超声显示食管壁五层结构边缘不清或中断的不均匀低回声病变。内镜超声显示7/11例（63.64%）纵隔淋巴结肿大。抗结核治疗导致了良好的反应与完全缓解的所有患者。结论食管结核临床少见，因缺乏诊断体征而易误诊。在吞咽困难或胸骨后疼痛的患者中，需要有高度的临床怀疑指数。内镜活检和内镜超声引导下细针穿刺活检有助于食管结核的正确诊断。
Background Tuberculosis of the esophagus is a rare clinical entity. There is a paucity of data on esophageal tuberculosis. This study aims to analyze the clinical and endoscopic features of esophageal tuberculosis over the last 20 years. Methods We retrospectively analyzed the data of 14 patients with esophageal tuberculosis between January 1999 to January 2019 at Nanfang Hospital. Tuberculosis was considered diagnostic if histopathological results showing epithelioid granuloma with or without caseous necrosis. Records of clinical features, imaging findings, endoscopic features and outcome of antitubercular treatment were evaluated. Results A total of 14 patients with definite esophageal tuberculosis were included. 7 patients (50%) presented with dysphagia, followed by 6 patients (42.86%) had retrosternal pain and another had cough (7.14%). On endoscopy, involvement of esophagus was observed at mid-segment mostly and findings included bulging lesions in 10 patients (71.43%), ulcer in 3 patients (21.43%), and tracheoesophageal fistula in 1 patient (7.14%). Endoscopic ultrasound showed a heterogeneous hypoechoic lesion with indistinct margins or interruption of the five layers structure of esophageal wall. Endoscopic ultrasound demonstrated mediastinal lymphadenopathy adjacent to esophageal pathology in 7/11(63.64%). Antitubercular treatment resulted in a good response with complete remission in all patients. Conclusions Esophageal tuberculosis is rare and frequently misdiagnosed due to the lack of diagnostic signs. There needs to be a high index of clinical suspicion among patients with dysphagia or retrosternal pain. Endoscopic biopsy and endoscopic ultrasound-guided FNA can help in achieving the correct diagnosis in esophageal tuberculosis.