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THE COVER Eosinophilic esophagitis: it’s not just kid’s stuff Victor L. Fox, MD, Samuel Nurko, MD, Glenn T. Furuta, MD
Figure 1. Endoscopic view of papular whitish exudate from a man with EE. Extension of the exudate together with rings can be seen along the length of the esophagus. (Photo courtesy of Peter Bonis, MD.)
Increasing evidence suggests that the esophagus serves as both a conduit for food and a participant in immune responses.1-6 This complex structure possesses innate elements of defense and orchestrates the migration of inflammatory cells, such as lymphocytes and eosinophils, into the squamous epithelium. In that regard, recent clinical experiences have identified an emerging entity termed eosinophilic esophagitis (EE). Although it is thought to occur primarily in children, a significant body of evidence suggests EE affects adults as well. Awareness and recognition of gross changes in the mucosal surface of the esophagus may provide the first clue to the diagnosis. Endoscopists are reminded of the importance of tissue sampling for detection of subtle abnormalities. Endoscopic assessment gathers information needed to establish the correct diagnosis of EE and, in so doing, may prevent unnecessary and potentially harmful interventions such as fundoplication. Also, early diagnosis of EE and initiation of appropriate treatment may avert or delay complications such as stricture or other long-term as yet unrecognized sequelae.
NEW METHODS & MATERIALS Novel magnified endoscopic findings of microvascular architecture in intramucosal gastric cancer Kenshi Yao, MD, PhD, Tatsuhiro Oishi, MD, PhD, Toshiyuki Matsui, MD, PhD, Tsuneyoshi Yao, MD, PhD, Akinori Iwashita, MD, PhD The color change observed endoscopically in early gastric cancer is thought to correlate with vascular density and architecture. This study investigated the endoscopic microvascular architecture in intramucosal gastric carcinoma in vivo. Intramucosal gastric carcinomas without ulceration in 27 patients were studied by using a new magnifying upper endoscope with attention to microvascular findings. It was concluded that magnified endoscopic observation of microvessels may be of assistance in the identification of intramucosal gastric carcinomas that exhibit only subtle changes in color and shape at standard endoscopy.
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Figure 5. A, Magnified view of pale cancerous mucosa showing disappearance of mucosal capillary network without any proliferation of vessels (white arrows). B, Magnified endoscopic view of marginal area between carcinomatous tissue and noncarcinomatous mucosa showing gradual reduction in vascularity between subepithelial noncancerous capillary network and cancerous mucosa (white arrow). 24A
GASTROINTESTINAL ENDOSCOPY
VOLUME 56, NO. 2, 2002
ON…
THE COVER Eosinophilic esophagitis: it’s not just kid’s stuff Victor L. Fox, MD, Samuel Nurko, MD, Glenn T. Furuta, MD
Figure 1. Endoscopic view of papular whitish exudate from a man with EE. Extension of the exudate together with rings can be seen along the length of the esophagus. (Photo courtesy of Peter Bonis, MD.)
Increasing evidence suggests that the esophagus serves as both a conduit for food and a participant in immune responses.1-6 This complex structure possesses innate elements of defense and orchestrates the migration of inflammatory cells, such as lymphocytes and eosinophils, into the squamous epithelium. In that regard, recent clinical experiences have identified an emerging entity termed eosinophilic esophagitis (EE). Although it is thought to occur primarily in children, a significant body of evidence suggests EE affects adults as well. Awareness and recognition of gross changes in the mucosal surface of the esophagus may provide the first clue to the diagnosis. Endoscopists are reminded of the importance of tissue sampling for detection of subtle abnormalities. Endoscopic assessment gathers information needed to establish the correct diagnosis of EE and, in so doing, may prevent unnecessary and potentially harmful interventions such as fundoplication. Also, early diagnosis of EE and initiation of appropriate treatment may avert or delay complications such as stricture or other long-term as yet unrecognized sequelae.
NEW METHODS & MATERIALS Novel magnified endoscopic findings of microvascular architecture in intramucosal gastric cancer Kenshi Yao, MD, PhD, Tatsuhiro Oishi, MD, PhD, Toshiyuki Matsui, MD, PhD, Tsuneyoshi Yao, MD, PhD, Akinori Iwashita, MD, PhD The color change observed endoscopically in early gastric cancer is thought to correlate with vascular density and architecture. This study investigated the endoscopic microvascular architecture in intramucosal gastric carcinoma in vivo. Intramucosal gastric carcinomas without ulceration in 27 patients were studied by using a new magnifying upper endoscope with attention to microvascular findings. It was concluded that magnified endoscopic observation of microvessels may be of assistance in the identification of intramucosal gastric carcinomas that exhibit only subtle changes in color and shape at standard endoscopy.
A
B
Figure 5. A, Magnified view of pale cancerous mucosa showing disappearance of mucosal capillary network without any proliferation of vessels (white arrows). B, Magnified endoscopic view of marginal area between carcinomatous tissue and noncarcinomatous mucosa showing gradual reduction in vascularity between subepithelial noncancerous capillary network and cancerous mucosa (white arrow). 24A
GASTROINTESTINAL ENDOSCOPY
VOLUME 56, NO. 2, 2002