, Volume 13, Issue 2, pp 200–207 | Cite as

Endocytoscopic observation of various types of esophagitis

  • Youichi KumagaiEmail author
  • Kaiyo Takubo
  • Kenro Kawada
  • Morihiro Higashi
  • Toru Ishiguro
  • Jun Sobajima
  • Minoru Fukuchi
  • Keiichiro Ishibashi
  • Erito Mochiki
  • Junko Aida
  • Tatsuyuki Kawano
  • Hideyuki Ishida
Original Article



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).


Endocytoscopy 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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Copyright information

© The Japan Esophageal Society and Springer Japan 2015

Authors and Affiliations

  • Youichi Kumagai
    • 1
    Email author
  • Kaiyo Takubo
    • 2
  • Kenro Kawada
    • 3
  • Morihiro Higashi
    • 4
  • Toru Ishiguro
    • 1
  • Jun Sobajima
    • 1
  • Minoru Fukuchi
    • 1
  • Keiichiro Ishibashi
    • 1
  • Erito Mochiki
    • 1
  • Junko Aida
    • 2
  • Tatsuyuki Kawano
    • 3
  • Hideyuki Ishida
    • 1
  1. 1.Department of Digestive Tract and General Surgery, Saitama Medical CenterSaitama Medical UniversityKawagoeJapan
  2. 2.Research Team for Geriatric PathologyTokyo Metropolitan Institute of GerontologyTokyoJapan
  3. 3.Department of Esophageal and General SurgeryTokyo Medical and Dental UniversityTokyoJapan
  4. 4.Department of Pathology, Saitama Medical CenterSaitama Medical UniversitySaitamaJapan

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