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Endocytoscopic observation of various types of esophagitis

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Abstract

Background

Use of an endocytoscopy system (ECS) makes it possible to omit biopsy histology for esophageal squamous cell carcinoma (ESCC). However, for differential diagnosis of ESCC, the endocytoscopic characteristics of esophagitis should be clarified.

Methods

We examined the morphology of surface cells in 20 cases of gastroesophageal reflux disease (GERD) (Grade M: 6 cases, A: 5 cases, B: 1 cases, C: 4 cases, D: 4 cases), five cases of candida esophagitis, and one case of eosinophilic esophagitis. One endoscopist classified the lesions using the modified type classification, and one pathologist judged the endocytoscopy images as “neoplastic”, “borderline”, or “non-neoplastic”.

Results

All cases of Grade M, A, and B GERD were classified as “type 1 or 2” by the endoscopist. However, 3/8 Grade C and D GERD lesions that had been diagnosed as regenerative squamous epithelium from biopsy histology were diagnosed as Type 3. All Grade M, A, and B cases were interpreted by the pathologist as “non-neoplastic”, whereas 4/8 Grade C and D GERD lesions, including three cases of regenerating epithelium, were diagnosed as “borderline” on the basis of ECS images. In 80 % of candida esophagitis cases, hyphae were visualized as white areas. Eosinophilic esophagitis showed a slight increase of cell density with marked infiltration of inflammatory cells.

Conclusion

Some cases of severe GERD cannot be clearly distinguished from esophageal squamous cell carcinoma (ESCC) using ECS, and therefore at present, cases of ESCC coexisting with severe GERD should not be diagnosed by ECS alone and probably require biopsy. (UMIN000007627).

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Acknowledgments

This study was supported by MEXT KAKENHI Grant number 26461047.

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Authors and Affiliations

  1. Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan

    Youichi Kumagai, Toru Ishiguro, Jun Sobajima, Minoru Fukuchi, Keiichiro Ishibashi, Erito Mochiki & Hideyuki Ishida

  2. Research Team for Geriatric Pathology, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan

    Kaiyo Takubo & Junko Aida

  3. Department of Esophageal and General Surgery, Tokyo Medical and Dental University, Tokyo, Japan

    Kenro Kawada & Tatsuyuki Kawano

  4. Department of Pathology, Saitama Medical Center, Saitama Medical University, Saitama, Japan

    Morihiro Higashi

Authors
  1. Youichi Kumagai
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  2. Kaiyo Takubo
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  3. Kenro Kawada
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  4. Morihiro Higashi
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  5. Toru Ishiguro
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  6. Jun Sobajima
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  7. Minoru Fukuchi
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  8. Keiichiro Ishibashi
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  9. Erito Mochiki
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  10. Junko Aida
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  11. Tatsuyuki Kawano
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  12. Hideyuki Ishida
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Correspondence to Youichi Kumagai.

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All authors declare that they have no conflicts of interest.

Human rights statement and informed consent

All procedures followed were in accordance with the ethical standards of the committees responsible for human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent for inclusion of tissue samples in this study was obtained from all patients or their representatives.

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Kumagai, Y., Takubo, K., Kawada, K. et al. Endocytoscopic observation of various types of esophagitis. Esophagus 13, 200–207 (2016). https://doi.org/10.1007/s10388-015-0517-1

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  • DOI: https://doi.org/10.1007/s10388-015-0517-1

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