Clinical and endoscopic features of esophageal tuberculosis: a 20-year retrospective study

Abstract

Background: Tuberculosis of the esophagus is a rare clinical entity. There is a paucity of data on esophageal tuberculosis. This study aims to analyze the clinical and endoscopic features of esophageal tuberculosis over the last 20 years.

Methods: We retrospectively analyzed the data of 14 patients with esophageal tuberculosis between January 1999 to January 2019 at Nanfang Hospital. Tuberculosis was considered diagnostic if histopathological results showing epithelioid granuloma with or without caseous necrosis. Records of clinical features, imaging findings, endoscopic features and outcome of antitubercular treatment were evaluated.

Results: A total of 14 patients with definite esophageal tuberculosis were included. 7 patients (50%) presented with dysphagia, followed by 6 patients (42.86%) had retrosternal pain and another had cough (7.14%). On endoscopy, involvement of esophagus was observed at mid-segment mostly and findings included bulging lesions in 10 patients (71.43%), ulcer in 3 patients (21.43%), and tracheoesophageal fistula in 1 patient (7.14%). Endoscopic ultrasound showed a heterogeneous hypoechoic lesion with indistinct margins or interruption of the five layers structure of esophageal wall. Endoscopic ultrasound demonstrated mediastinal lymphadenopathy adjacent to esophageal pathology in 7/11(63.64%). Antitubercular treatment resulted in a good response with complete remission in all patients.

Conclusions: Esophageal tuberculosis is rare and frequently misdiagnosed due to the lack of diagnostic signs. There needs to be a high index of clinical suspicion among patients with dysphagia or retrosternal pain. Endoscopic biopsy and endoscopic ultrasound-guided FNA can help in achieving the correct diagnosis in esophageal tuberculosis.

Keywords: Esophageal tuberculosis; endoscopic ultrasound; endoscopy.