Abe Y1,2, Sasaki Y1, Kon T1, Ueno Y1.
Intern Med. 2020 Mar 19. doi: 10.2169/internalmedicine.4381-19. [Epub ahead of print]
A 74-year-old man with dysphagia underwent screening endoscopy. Characteristic endoscopic findings of eosinophilic esophagitis (EoE), such as furrows, rings, or exudates, were not clearly observed, but edematous mucosa was vaguely detected on white light imaging (Picture 1a). These areas were highlighted as a beige color area on blue laser imaging (BLI) (Picture 1b) and a yellowish area on linked color imaging (LCI) (Picture 1c and 1d). Intense eosinophilic infiltration was observed in these image-enhanced areas histologically, but no similar observation was made in
the normal-appearing mucosa (Picture 2a, 2b). This patient was ultimately diagnosed with EoE. A meta-analysis reported that 15% of adult patients have no characteristic endoscopic manifestations of EoE (1). BLI and LCI are newly developed endoscopic imaging technologies on which the visibility of various organic lesions, such as inflammation or tumors, is enhanced (2). These technologies may improve the diagnostic accuracy of EoE by increasing the visibility of esophageal eosinophilia.
1 Department of Gastroenterology, Yamagata University Faculty of Medicine, Japan
2 Division of Endoscopy, Yamagata University Hospital, Japan