• Anthracosis
• Case report
• Endoscopic ultrasound-guided fine needle aspiration
• Gastrointestinal endoscopy
• Gastrointestinal tuberculosis
• Lymph node tuberculosis

• Male
• Humans
• Aged
• Esophagus/pathology
• Tuberculosis, Lymph Node/diagnosis
• Anthracosis/complications
• Anthracosis/diagnosis
• Anthracosis/pathology
• Lung/pathology
• Antitubercular Agents/therapeutic use

• Esophagus
• Medically curable
• Misdiagnosis
• Surgery for complications
• Tuberculosis

• Esophageal tuberculosis
• endoscopic ultrasound
• endoscopy

Esophageal tuberculosis (ET) is relatively rare, and the diagnosis is challenging. The aim of this study was to evaluate the clinical features of ET and highlight the role of endoscopic ultrasonography (EUS) in the diagnosis of pathologically undiagnosed ET.

We retrospectively analysed the clinical features, radiological performances, conventional endoscopic appearances, EUS features, treatment and outcomes of pathologically undiagnosed ET between January 2011 and December 2018. All 9 patients failed to be diagnosed by at least two repeated biopsies (such as routine biopsy, multipoint or deep biopsy, and even or EUS-guided fine-needle aspiration (EUS-FNA)).

Nine patients (66.7% female) with a mean age of 45 years (range 29–59) complained of retrosternal pain or discomfort, or (and) dysphagia. Esophagoscopy demonstrated protruding lesions in the mucosa with central ulcers or erosion in five patients, submucosal bulges with smooth surfaces in one patient, submucosal bulges with diverticula in one patient, ulcers with suspicious fistula formation in one patient, and multiple ulcers in one patient. None of the patients received confirmed histopathological or bacteriological diagnoses by repeated biopsies. However, they were first suspected to have ET based on EUS examination. Because EUS found some characteristic ultrasonographic changes, which were very helpful for the diagnosis of ET when combined with clinical manifestations, the patients subsequently received diagnostic antituberculosis therapy. Finally, the patients recovered or improved with follow-up times ranging from 3 to 10 months.

EUS could help in the diagnosis of ET on basis of EUS features like poorly defined esophageal wall structure, enlarged paraesophageal or mediastinal lymph nodes, hypoechoic lesions of esophageal wall that are linked to the enlarged paraesophageal lymph nodes. However all attempts should be made to obtain histological or microbiological diagnosis.

• Dysphagia
• Endoscopic ultrasonography (EUS)
• Esophageal tuberculosis (ET)
• Retrosternal pain

Esophageal involvement in tuberculosis (TB) is rare and is usually secondary. Data on esophageal TB are scarce. We aimed to analyze clinical and endoscopic features and outcomes of treatment in esophageal TB.

We retrospectively identified patients with esophageal TB from January 2014 to December 2016 at GB Pant Hospital. Well‐defined granuloma with or without caseation and/or acid‐fast bacilli on staining either from esophageal biopsy or the adjacent mediastinal lymph node fine‐needle aspiration cytology (FNAC) specimen, along with clinical features and response to antitubercular therapy (ATT), were collectively considered to diagnose definite TB. Treatment received and response to therapy were documented and analyzed.

A total of 19 patients had definite esophageal TB, and the median age of patients was 39 years (14–65 years) and 10 (52.6%) patients were female. The most common presenting symptom was dysphagia (n = 16, 84%) followed by odynophagia (n = 8, 42%). On endoscopy, the mid‐esophagus was the most common site of involvement, and findings included ulcers (n = 17), elevated lesions (n = 9), and fistulae (n = 4) in patients. The mediastinal lymphadenopathy was present in all patients, with parenchymal lesions seen in three patients. The endoscopic mucosal biopsies were diagnostic in 11 patients, and in the remaining 8 patients, endoscopic ultrasound‐guided FNAC from the mediastinal lymph nodes was diagnostic. A total of 18 patients completely responded to ATT, and 1 patient had partial response with persistent fistulae requiring additional treatment.

Esophagus involvement is rare in TB; endoscopic mucosal biopsy and EUS‐guided FNAC is diagnostic, and the response to ATT is excellent.

• endoscopic ultrasound
• endoscopy: upper gastrointestinal
• esophagus
• fistula
• tuberculosis

To establish a classification method for differential diagnosis of colorectal ulcerative diseases, especially Crohn’s disease (CD), primary intestinal lymphoma (PIL) and intestinal tuberculosis (ITB).

We searched the in-patient medical record database for confirmed cases of CD, PIL and ITB from 2008 to 2015 at our center, collected data on endoscopic ultrasound (EUS) from randomly-chosen patients who formed the training set, conducted univariate logistic regression analysis to summarize EUS features of CD, PIL and ITB, and created a diagnostic classification method. All cases found to have colorectal ulcers using EUS were obtained from the endoscopy database and formed the test set. We then removed the cases which were easily diagnosed, and the remaining cases formed the perplexing test set. We re-diagnosed the cases in the three sets using the classification method, determined EUS diagnostic accuracies, and adjusted the classification accordingly. Finally, the re-diagnosing and accuracy-calculating steps were repeated.

In total, 272 CD, 60 PIL and 39 ITB cases were diagnosed from 2008 to 2015 based on the in-patient database, and 200 CD, 30 PIL and 20 ITB cases were randomly chosen to form the training set. The EUS features were summarized as follows: CD: Thickened submucosa with a slightly high echo level and visible layer; PIL: Absent layer and diffuse hypoechoic mass; and ITB: Thickened mucosa with a high or slightly high echo level and visible layer. The test set consisted of 77 CD, 30 PIL, 23 ITB and 140 cases of other diseases obtained from the endoscopy database. Seventy-four cases were excluded to form the perplexing test set. After adjustment of the classification, EUS diagnostic accuracies for CD, PIL and ITB were 83.6% (209/250), 97.2% (243/250) and 85.6% (214/250) in the training set, were 89.3% (241/270), 97.8% (264/270) and 84.1% (227/270) in the test set, and were 86.7% (170/196), 98.0% (192/196) and 85.2% (167/196) in the perplexing set, respectively.

The EUS features of CD, PIL and ITB are different. The diagnostic classification method is reliable in the differential diagnosis of colorectal ulcerative diseases.

• Endoscopic ultrasound
• Ulcerative diseases
• Crohn’s disease
• Primary intestinal lymphoma
• Intestinal tuberculosis
• Classification

• Adolescent
• Adult
• Aged
• Crohn Disease/diagnostic imaging
• Diagnosis, Differential
• Endosonography/methods
• Female
• Humans
• Intestinal Neoplasms/diagnostic imaging
• Logistic Models
• Lymphoma/diagnostic imaging
• Male
• Middle Aged
• Tuberculosis, Gastrointestinal/diagnostic imaging
• Young Adult

• EUS
• diagnosis
• esophageal tuberculosis

• Adult
• Aged
• Endosonography
• Esophageal Diseases/diagnostic imaging
• Esophageal Diseases/microbiology
• Esophagus/diagnostic imaging
• Esophagus/microbiology
• Female
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Tuberculosis, Gastrointestinal/diagnostic imaging

AIM: To summarize the endoscopic ultrasonography (EUS) characteristics of esophageal tuberculosis and evaluate the role of EUS and EUS guided fine needle aspiration (EUS-FNA) in the diagnosis and differential diagnosis of esophageal tuberculosis.

METHODS: The clinical data, EUS and EUS-FNA data for 11 patients with esophageal tuberculosis were collected and analyzed retrospectively.

RESULTS: Eight lesions were found in the middle part of the esophagus and 3 in the upper part. The lesions demonstrated as protrusion in 7 cases and ulceration in 4 cases. The layers of the esophageal wall were unclear or disappeared in some cases, and in some patients low echo occupying lesions inside or outside the esophageal wall were showed by EUS. The internal echo of the lesions was heterogeneous, and strong echo spots could be observed. In most cases, enlarged mediastinal lymph nodes were observed. EUS-FNA was used to take biopsy specimens in 7 cases: caseouse necrosis was found in 2 cases; 3 biopsy specimens suggested tuberculosis; no cancer cells were observed in 2 biopsy specimens.

CONCLUSION: EUS can not only show the morphology and internal echo of the lesions, as well as the relationship between the lesions and esophageal wall, but also allow to observe the lymph nodes outside the esophageal wall. Biopsy specimens can be taken by EUS-FNA. EUS and EUS-FNA have high value in the diagnosis of esophageal tuberculosis.

• Esophageal tuberculosis
• Endoscopic ultrasonography
• Endoscopic ultrasonography guided fine needle aspiration

• Esophageal tuberculosis (ET)
• dysphagia
• esophagopleural fistula
• video-assisted thoracoscopic surgery (VATS)

Esophageal tuberculosis is a rare clinical entity diagnosed based on the presence of inflammatory granulomatous lesions caused by Mycobacterium tuberculosis invading the esophageal wall. It is often misdiagnosed as esophageal cancer or esophageal leiomyoma. Esophageal tuberculosis often presents as difficulty in swallowing, chest pain, weight loss and fever. These symptoms are unspecific and are often insufficient to establish a preoperative diagnosis. Esophageal tuberculosis with tuberculous peritonitis is very rare. Here, we report a case of esophageal tuberculosis with tuberculous peritonitis. We also performed a literature review to summarize the diagnosis and treatment of this rare disease.

• Esophageal tuberculosis
• Tuberculous peritonitis
• Mycobacterium tuberculosis