Endoscopic features of eosinophilic lesion of the esophagus in children

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Abstract

Eosinophilic esophagitis (EoE) is a chronic, slowly progressive immune-mediated disease considered a separate clinical and morphological syndrome. The incidence of EoE is currently tending to increase in children. Endoscopy with biopsy is essential for diagnosing EoE in children and adults. The article presents modern endoscopic capabilities in pediatric practice. Attention is drawn to the need to use the available modern endoscopic protocols for the diagnosis of eosinophilic lesions of the esophagus in children; the role of correct and high-quality endoscopic and pathomorphological interpretation of the data obtained for the verification of the diagnosis in EoE is emphasized.

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About the authors

Anastasia S. Koshurnikova

Bashlyaeva Children’s City Clinical Hospital

Author for correspondence.
Email: saller03@mail.ru
ORCID iD: 0000-0002-2306-9743

Cand. Sci. (Med.)

Russian Federation, Moscow

Ismail M. Osmanov

Bashlyaeva Children’s City Clinical Hospital; Pirogov Russian National Research Medical University

Email: saller03@mail.ru
ORCID iD: 0000-0003-3181-9601

D. Sci. (Med.)

Russian Federation, Moscow; Moscow

Anatolii S. Kuzmin

Bashlyaeva Children’s City Clinical Hospital

Email: saller03@mail.ru

endoscopist

Russian Federation, Moscow

Ekaterina V. Scorobogatova

Bashlyaeva Children’s City Clinical Hospital; Russian Medical Academy of Continuous Professional Education

Email: saller03@mail.ru
ORCID iD: 0009-0003-9227-9378

Cand. Sci. (Med.)

Russian Federation, Moscow; Moscow

Irina V. Berezhnaya

Russian Medical Academy of Continuous Professional Education

Email: saller03@mail.ru
ORCID iD: 0000-0002-2847-6268

Cand. Sci. (Med.)

Russian Federation, Moscow

Irina N. Zakharova

Russian Medical Academy of Continuous Professional Education

Email: kapelovich@hpmp.ru
ORCID iD: 0000-0003-4200-4598

D. Sci. (Med.), Prof.

Russian Federation, Moscow

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2. Fig. 1. Endoscopic image. Cicatricial ulcerative stenosis of the middle third of the esophagus in a 7-year-old child with late eosinophilic esophagitis (EoE) verification: a – the middle third of the esophagus is narrowed, 9.3 mm endoscope cannot pass through; b – cicatricial ulcerative defect of the middle third of the esophagus with stenosis.

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3. Fig. 2. Endoscopic image of the mucosa of the middle third of the esophagus with verified EoE: moderate mucosa edema with spots of whitish exudate.

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4. Fig. 3. Endoscopic image of the mucosa of the middle third of the esophagus: moderate mucosa edema, multiple spots of whitish exudate along all walls, which does not wash off, longitudinal grooves.

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5. Fig. 4. Endoscopic image of the mucosa of the middle third of the esophagus: severe edema of the mucosa of the esophagus, multiple spots of whitish exudate along all walls, which does not wash off, multiple concentric stenoses.

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6. Fig. 5. Endoscopic image in white light and optical chromoscopy in a patient with EoE: a – white light examination: pink mucosa, scarce mucous secretion; b – examination using digital chromoscopy: more exudate along the walls and longitudinal grooves, which corresponds to the endoscopic manifestations of EoE.

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7. Fig. 6. Biopsy from the upper third of the esophagus in a 5-year-old child with EoE (marked bleeding).

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8. Fig. 7. Histology slide of the biopsy specimen of the esophageal mucosa (description: serial section of one fragment of the esophageal mucosa with a pronounced eosinophil infiltration of >50 in the field of view at ×40, elongation of the fibrovascular papillae, basal cell hyperplasia, epithelial cell dystrophy. In lamina propria: fibrosis, infiltration by a few eosinophils).

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9. Fig. 8. Endoscopic image of the esophageal mucosa: a – candidal lesion of the esophagus; b – erosive esophagitis due to gastroesophageal reflux.

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