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Novel endoscopic approaches using the endocytoscopy for the target biopsy in esophageal eosinophilia

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Abstract

Background and aims

Multiple biopsies are recommended for the diagnosis of eosinophilic esophagitis (EoE) because inflammatory changes are frequently patchy. Reports on EoE using endocytoscopy (ECS) are limited. This present study aimed to assess if diagnostic yield improves by adding ECS on conventional white light imaging (WLI) in patients with esophageal eosinophilia (EE).

Methods

A total of 284 biopsy specimens from 71 patients with a known diagnosis of EE were enrolled and divided into the WLI group (156 specimens) or the ECS group (128 specimens). Four biopsies from 5 and 10 cm proximal to the esophagogastric junction were taken from each patient. In the ECS group, the biopsy was performed where bilobed nuclei were observed. The biopsy sensitivity for EE, eosinophil count of a single specimen and the biopsy sensitivity of each endoscopic finding were evaluated between both groups.

Results

The sensitivity of a single biopsy specimen was higher in the ECS group than that of the WLI group (62.5 vs. 41.7%, P < 0.001). In addition, the median eosinophil count in the ECS group was significantly higher [19 vs. 6.5/high-power field (HPF), P < 0.001]. For each endoscopic finding, ECS-based biopsy had higher sensitivity than that of WLI in the diagnosis of edema (33.1 vs. 11.3%, P = 0.007) and linear furrows (75.8 vs. 52%, P = 0.005).

Conclusion

This study showed that adding ECS to WLI improved the biopsy sensitivity and eosinophil detection in patients with EE.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Graduate School of Medicine, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan

    Koichi Muroi, Naomi Kakushima, Kazuhiro Furukawa, Satoshi Furune, Nobuhito Ito, Takashi Hirose, Emiko Hida, Tomohiko Suzuki, Takahiro Suzuki, Keiko Hirai, Hiroyuki Shibata, Eri Ishikawa, Tsunaki Sawada, Keiko Maeda, Takeshi Yamamura, Eizaburo Ohno, Masanao Nakamura, Mitsuhiro Fujishiro & Hiroki Kawashima

  2. Department of Gastroenterology, Graduate School of Medicine, Tokyo University, Tokyo, Japan

    Naomi Kakushima & Mitsuhiro Fujishiro

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  1. Koichi Muroi
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  2. Naomi Kakushima
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  3. Kazuhiro Furukawa
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  19. Hiroki Kawashima
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Contributions

All the authors contributed to the conception and design of the study. Material preparation, data collection, and analyses were performed by the KM. The first draft of the manuscript was written by KM, NK and KF commented on the previous versions of the manuscript. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Koichi Muroi.

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Ethical statement

This study was approved by the Ethics Committee of Nagoya University and was registered in the University Hospital Medical Information Network (UMIN) Clinical Trials (No. 000033251). This study was conducted ethically in accordance with the World Medical Association Declaration of Helsinki Update 2013.

Conflict of interest

All authors declare that they have no conflict of interest.

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Muroi, K., Kakushima, N., Furukawa, K. et al. Novel endoscopic approaches using the endocytoscopy for the target biopsy in esophageal eosinophilia. Esophagus 20, 325–332 (2023). https://doi.org/10.1007/s10388-022-00963-0

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  • DOI: https://doi.org/10.1007/s10388-022-00963-0

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