Endocytoscopic observation of various types of esophagitis
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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.
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”.
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.
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).
KeywordsEndocytoscopy system Gastroesophageal reflux disease Candida esophagitis Eosinophilic esophagitis Esophagus
This study was supported by MEXT KAKENHI Grant number 26461047.
Compliance with ethical standards
Conflict of interest
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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