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Endoscopic Ultrasound for Gastrointestinal Tuberculosis

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Tuberculosis of the Gastrointestinal system

Abstract

Endoscopic ultrasound (EUS) is a useful tool to diagnose abdominal tuberculosis (AT), as most of the abdominal structures, i.e. lymph nodes, solid organs, gastrointestinal luminal and sub-epithelial lesions as also the peritoneum are very well visualized as well as are accessible for tissue acquisition. There are certain characterstic morphological features seen on EUS in favour for AT. However, the feasibility of acquiring tissue for microbiological and cytological evaluation could help in reaching a diagnosis. TB is diagnosed on basis of presence of caseating granulomas on cytology with either acid-fast bacilli (AFB) positivity on Ziehl-Neelsen (ZN) stain or positive geneXpert or TB-PCR or positive mycobacterial culture. EUS can also be used as a good modality for treatment response on follow-up.

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Abbreviations

AFB:

Acid-fast bacilli

AT:

Abdominal tuberculosis

ATT:

Anti-tubercular treatment

CE-EUS:

Contrast-enhanced EUS

CH-EUS:

Contrast-enhanced harmonic EUS

ET:

Esophageal tuberculosis

EUS:

Endoscopic ultrasound

EUS-E:

EUS elastography

EUS-FNA:

Endoscopic Ultrasound-guided Fine needle aspiration

EUS-FNB:

Endoscopic Ultrasound-guided Fine needle biopsy

LN:

Lymph node

PUO:

Pyrexia of unknown origin

SMTs:

Submucosal tumours

SOL:

Space occupying lesion

ZN:

Ziehl-Neelsen

References

  1. Dhir V, Mathew P, Bhandari SP, et al. Endosonography-guided fine needle aspiration cytology of intra-abdominal lymph nodes with unknown primary in a tuberculosis endemic region. J Gastroenterol Hepatol. 2011;26:1733–9.

    Article  Google Scholar 

  2. Catalano MF, Sivak MV, Rice T, et al. Endosonographic features predictive of lymph node metastasis. Gastrointest Endosc. 1994;40(4):442–6.

    Article  CAS  PubMed  Google Scholar 

  3. Bansal RK, Choudhary NS, Patle SK, et al. Diagnostic adequacy and safety of endoscopic ultrasound-guided fine-needle aspiration in patients with lymphadenopathy in a large cohort. Endosc Int Open. 2018;06:E421–4.

    Article  Google Scholar 

  4. Li C, Shuai Y, Zhou X. Endoscopic ultrasound guided fine needle aspiration for the diagnosis of intra-abdominal lymphadenopathy: a systematic review and meta-analysis. Scand J Gastroenterol. 2020;55(1):114–22.

    Article  PubMed  Google Scholar 

  5. Bodh V, Choudhary NS, Puri R, et al. Endoscopic ultrasound characteristics of tubercular lymphadenopathy in comparison to reactive lymph nodes. Indian J Gastroenterol. 2016;35(1):55–9.

    Article  PubMed  Google Scholar 

  6. Choudhary NS, Bodh V, Kumar N, Puri R, Sarin H, Guleria M, et al. Yield of endoscopic ultrasound-guided fine needle aspiration for subcentimetric lymph nodes: a comparison to larger nodes. Endosc Ultrasound. 2017;6:168–73.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Choudhary NS, Bansal RK, Puri R, et al. Impact and safety of endoscopic ultrasound guided fine needle aspiration on patients with cirrhosis and pyrexia of unknown origin in India. Endosc Int Open. 2016;4:E953–6.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Choudhary NS, Puri R, Saigal S, et al. Impact of endoscopic ultrasound-guided fine-needle aspiration in prospective liver transplant recipients with hepatocellular carcinoma and lymphadenopathy. Indian J Gastroenterol. 2016;35:465–8.

    Article  PubMed  Google Scholar 

  9. Xu W, Shi J, Zeng X, et al. EUS elastography for the differentiation of benign and malignant lymph nodes: a meta-analysis. Gastrointest Endosc. 2011;74(5):1001–9.

    Article  PubMed  Google Scholar 

  10. Lisotti A, Ricci C, Serrani M, et al. Contrast-enhanced endoscopic ultrasound for the differential diagnosis between benign and malignant lymph nodes: a meta-analysis. Endosc Int Open. 2019;7(4):E504–13.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Porter AE. The bacteriolytic action of gland extracts on tubercle bacilli. J Hyg (Lond). 1917;16(1):55–65.

    Article  CAS  Google Scholar 

  12. Day A, Gibbs W. The action of pancreatic juice on bacteria. J Infect Dis. 1930;46:26–30.

    Article  CAS  Google Scholar 

  13. Knowles KF, Saltman D, Robson HG, Lalonde R. Tuberculous pancreatitis. Tubercle. 1990;71(1):65–8.

    Article  CAS  PubMed  Google Scholar 

  14. Panic N, Maetzel H, Bulajic M, et al. Pancreatic tuberculosis: a systematic review of symptoms, diagnosis and treatment. United Eur Gastroenterol J. Epub ahead of print 17 Jan 2020. 2050640620902353

    Google Scholar 

  15. Auerbach O. Acute generalized miliary tuberculosis. Am J Pathol. 1944;20:121–36.

    CAS  PubMed  PubMed Central  Google Scholar 

  16. Bhansali SK. Abdominal tuberculosis. Experiences with 300 cases. Am J Gastroenterol. 1977;67:324–37.

    CAS  PubMed  Google Scholar 

  17. Sharma V, Rana SS, Kumar A, et al. Pancreatic tuberculosis. J Gastroenterol Hepatol. 2016;31:310–8.

    Article  PubMed  Google Scholar 

  18. Xia F, Poon RT, Wang SG, et al. Tuberculosis of pancreas and peripancreatic lymph nodes in immunocompetent patients: experience from China. World J Gastroenterol. 2003;9:1361–4.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Ibrahim GF, Al-Nakshabandi NA. Pancreatic tuberculosis: role of multidetector computed tomography. Can Assoc Radiol J. 2011;62:260–4.

    Article  PubMed  Google Scholar 

  20. Kim JB, Lee SS, Kim SH, et al. Peripancreatic tuberculous lymphadenopathy masquerading as pancreatic malignancy: a single-center experience. J Gastroenterol Hepatol. 2014;29:409–16.

    Article  PubMed  Google Scholar 

  21. Puri R, Thandassery RB, Eloubeidi MA, et al. Diagnosis of isolated pancreatic tuberculosis: the role of EUS-guided FNA cytology. Gastrointest Endosc. 2012;75:900–4.

    Article  PubMed  Google Scholar 

  22. Nagar AM, Raut AA, Morani AC, et al. Pancreatic tuberculosis: a clinical and imaging review of 32 cases. J Comput Assist Tomogr. 2009;33:136–41.

    Article  PubMed  Google Scholar 

  23. Rana S, Sharma V, Sharma R, et al. Involvement of mediastinal/intra-abdominal lymph nodes, spleen, liver, and left adrenal in presumed isolated pancreatic tuberculosis: an endoscopic ultrasound study. J Digest Endoscop. 2015;6:15–8.

    Article  Google Scholar 

  24. Verma S, Singh A, Kumar-M P, Sharma V. Systematic review on pancreatic tuberculosis: more questions united European. Gastroenterol J. 2020;8(4):489–90.

    Google Scholar 

  25. Rana SS, Bhasin DK, Srinivasan R, Sampath S, Mittal BR, Singh K. Distinctive endoscopic ultrasound features of isolated pancreatic tuberculosis and requirements for biliary stenting. Clin Gastroenterol Hepatol. 2012;10(3):323–5.

    Article  PubMed  Google Scholar 

  26. American Joint Committee on Cancer. Exocrine pancreas. In: Greene FL, Page DL, Fleming ID, Fritz AG, Balch CM, editors. AJCC cancer staging hand- book, vol. 182. 6th ed. New York: Springer-Verlag; 2002. [ISBN 0-387-95271-3].

    Google Scholar 

  27. Sharma V, Rana SS, Bhasin DK. Endoscopic ultrasound guided fine needle aspiration for diagnosis of pancreatic tuberculosis. JOP. 2013;14(5):521.

    PubMed  Google Scholar 

  28. Brusko G, Melvin WS, Fromkes JJ, Ellison EC. Pancreatic tuberculosis. Am Surg. 1995;61(6):513–5.

    CAS  PubMed  Google Scholar 

  29. Sharma KV, Venkatesan AM, Swerdlow D, et al. Image-guided adrenal and renal biopsy. Tech Vasc Interv Radiol. 2010;13:100–9.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Bansal RK, Choudhary NS, Patle SK, et al. Endoscopic ultrasound-guided fine-needle aspiration of enlarged adrenals in patients with pyrexia of unknown origin: a single-center experience of 52 cases. Indian J Gastroenterol. 2018;37(2):108–12.

    Article  PubMed  Google Scholar 

  31. Fritscher-Ravens A, Mylonaki M, Pantes A, et al. Endoscopic ultrasound-guided biopsy for the diagnosis of focal lesions of the spleen. Am J Gastroenterol. 2003;98:1022–7.

    Article  PubMed  Google Scholar 

  32. Eloubeidi MA, Varadarajulu S, Eltoum I, et al. Transgastric endoscopic ultrasound-guided fine-needle aspiration biopsy and flow cytometry of suspected lymphoma of the spleen. Endoscopy. 2006;38:617–20.

    Article  CAS  PubMed  Google Scholar 

  33. Iwashita T, Yasuda I, Tsurumi H, et al. Endoscopic ultrasound- guided fine needle aspiration biopsy for splenic tumor: a case series. Endoscopy. 2009;41:179–82.

    Article  CAS  PubMed  Google Scholar 

  34. Rana SS, Sharma V, Sharma R, Srinivasan R, Gupta R. Safety and utility of endoscopic ultrasound-guided fine-needle aspiration of focal splenic lesions: a retrospective analysis. Ann Gastroenterol. 2017;30(5):559–63.

    PubMed  PubMed Central  Google Scholar 

  35. Eng J, Sabanathan S. Tuberculosis of the esophagus. Dig Dis Sci. 1991;36:536–40.

    Article  CAS  PubMed  Google Scholar 

  36. Naqi B, Lal A, Kochhar R, et al. Imaging of esophageal tuberculosis: a review of 23 cases. Acta Radiol. 2003;44:329–3.

    Google Scholar 

  37. Abid S, Jafri W, Hamid S, Khan H, Hussainy A. Endoscopic features of esophageal tuberculosis. Gastrointest Endosc. 2003;57:759–62.

    Article  PubMed  Google Scholar 

  38. Aydin A, Tekin F, Ozutemiz O, Musoglu A. Value of endoscopic ultrasonography for diagnosis of esophageal tuberculosis: report of two cases. Dig Dis Sci. 2006;51:1673–6.

    Article  PubMed  Google Scholar 

  39. Han XM, Yang JM, Xu LH, Nie LM, Zhao ZS. Endoscopic ultrasonography in esophageal tuberculosis. Endoscopy. 2008;40:701–2.

    Article  PubMed  Google Scholar 

  40. Puri R, Khaliq A, Kumar M, Sud R, Vasdev N. Esophageal tuberculosis: role of endoscopic ultrasound in diagnosis. Dis Esophagus. 2012;25:102–6.

    Article  CAS  PubMed  Google Scholar 

  41. Rana S, Bhasin DK, Rao C, Srinivasan R, Singh K. Tuberculosis presenting as dysphagia: clinical, endoscopic, radiological, and endosonographic features. Endosc Ultrasound. 2013;2:92–5.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Tang Y, Shi W, Sun X, Xi W. Endoscopic ultrasound in diagnosis of esophageal tuberculosis: 10-year experience at a tertiary care center. Dis Esophagus. 2017;30:1–6.

    Article  PubMed  Google Scholar 

  43. Gupta B, Mathew S, Bhalla S. Pyloric obstruction due to gastric tuberculosis – an endoscopic diagnosis. Postgrad Med J. 1990;66:63–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Rana SS, Bhasin DK, Chandail VS, Gupta R, Nada R, Kang M, et al. Endoscopic balloon dilatation without fluoroscopy for treating gastric outlet obstruction because of benign etiologies. Surg Endosc. 2011;25:1579–84.

    Article  PubMed  Google Scholar 

  45. Rana SS, Bhasin DK, Srinivasan R, Singh K. Gastric outlet obstruction caused by tuberculosis and diagnosed by endoscopic ultrasound-guided fine needle aspiration. Endoscopy. 2011;43(Suppl 2):E117–8.

    Article  PubMed  Google Scholar 

  46. Gupta V, Goel MM, Noushif M, Rai P, Gupta P, Chandra A. Primary gastric tuberculosis mimicking gastrointestinal stromal tumor. Am J Gastroenterol. 2012;107:1269–70.

    Article  PubMed  Google Scholar 

  47. Kim SH, Park JH, Kang KH, Lee JH, Park CK, Cho CM, et al. Gastric tuberculosis presenting as a submucosal tumor. Gastrointest Endosc. 2005;61:319–22.

    Article  PubMed  Google Scholar 

  48. Khan FY, AlAni A, Al-Rikabi A, Mizrakhshi A, Mel-M O. Primary gastric fundus tuberculosis in immunocompetent patient: a case report and literature review. Braz J Infect Dis. 2008;12:453–5.

    Article  PubMed  Google Scholar 

  49. Tromba JL, Inglese R, Rieders B, Todaro R. Primary gastric tuberculosis presenting as pyloric outlet obstruction. Am J Gastroenterol. 1991;86:1820–2.

    CAS  PubMed  Google Scholar 

  50. McGee GS, Williams LF, Potts J, Barnwell S, Sawyers JL. Gastrointestinal tuberculosis: resurgence of an old pathogen. Am Surg. 1989;55:16–20.

    CAS  PubMed  Google Scholar 

  51. Sharma V, Rana SS, Gunjan D, Chhabra P, Sharma R, Bhasin DK. Primary gastric tuberculosis mimicking a submucosal tumor. J Dig Endosc. 2015;6:130–2.

    Article  Google Scholar 

  52. Zhu R, Zhou Y, Wang H, et al. Gastric tuberculosis mimicking submucosal tumor: a case series. BMC Gastroenterol. 2020;20:23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Mimidis KR. Peritoneal tuberculosis. Ann Gastroenterol. 2007;18(August (3))

    Google Scholar 

  54. Sharma V, Soni H, Kumar-M P, Dawra S, Mishra S, Mandavdhare HS, Singh H, Dutta U. Diagnostic accuracy of the Xpert MTB/RIF assay for abdominal tuberculosis: a systematic review and meta-analysis. Expert Rev Anti-Infect Ther. 2021;19(2):253–65.

    Article  CAS  PubMed  Google Scholar 

  55. Daswani R, Kumar A, Singla V, et al. Endoscopic ultrasound (EUS) guided fine needle aspiration: a new modality to diagnose peritoneal tuberculosis in presence of decompensated cirrhosis—a case series and review of literature. J Clin Exp Hepatol. 2018;8(2):205–9.

    Article  PubMed  Google Scholar 

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Acknowledgement

Dr. Sweety Bansal for help in literature search.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepato-biliary sciences, Fortis Memorial Research Institute, Gurgaon, India

    Rinkesh Kumar Bansal & Gursimran Kaur

  2. Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, India

    Narendra S. Choudhary

  3. Institute of Digestive and Hepatobiliary Sciences, Medanta-The Medicity, Gurgaon, India

    Rajesh Puri

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  1. Rinkesh Kumar Bansal
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  2. Gursimran Kaur
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  3. Narendra S. Choudhary
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  4. Rajesh Puri
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Editors and Affiliations

  1. Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Vishal Sharma

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Bansal, R.K., Kaur, G., Choudhary, N.S., Puri, R. (2022). Endoscopic Ultrasound for Gastrointestinal Tuberculosis. In: Sharma, V. (eds) Tuberculosis of the Gastrointestinal system. Springer, Singapore. https://doi.org/10.1007/978-981-16-9053-2_19

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