Current role of endoscopic ultrasound for gastrointestinal and abdominal tuberculosis

Abstract

A high incidence of tuberculosis (TB), especially in endemic countries, makes this infectious disease a concern. Abdominal TB contributes to 10% of extrapulmonary TB. Due to nonspecific clinical, radiological, and endoscopic findings, diagnosing abdominal TB continues to be a challenge. Hence, a precise diagnosis is needed. The diagnosis of gastrointestinal disease using endoscopic ultrasound (EUS) is often performed due to its high resolution and ability to provide a real-time visual representation of the gastrointestinal tract and extramural structures. EUS-guided fine-needle aspiration (FNA) and fineneedle biopsy (FNB) have helped diagnose TB as they offer an adequate specimen for cytology or histopathological examination. This method is considered safer, more effective, and more efficient. The capacity of EUS to diagnose abdominal TB based on the affected organs was examined via a literature search. We reviewed the role of EUS in diagnosing esophageal, gastric, pancreatic, peripancreatic, hepatosplenic, peritoneal, and intestinal TB. Generally, EUS aids in diagnosing abdominal TB. In some organs, it is superior to other diagnostic modalities. However, further examinations, such as cytology or histopathology and microbial, are still needed. We also studied the roles of EUS-FNA and EUS-FNB. EUS-FNA has shown a high diagnostic yield in esophageal (94.3-100%), pancreatic and peripancreatic (76.2%), and intestinal TB (84.1%). As minimally invasive methods, EUS-FNA and EUS-FNB can successfully provide sufficient samples. EUS is a functional diagnostic modality for abdominal TB. EUS-FNA and EUS-FNB provide sufficient samples safely and efficiently for further cytology, histopathology, and microbial examinations. Esophageal tuberculosisEsophageal TB is uncommon and has nonspecific clinical, laboratory, radiological, and endoscopic features. With prevalence

Comments and Illustrations of Ultrasound Findings in Extrapulmonary Tuberculosis Manifestations

“…Mediastinal lymph nodes can be biopsied using EUS-or EBUS-guided FNA or FNB. Via paraoesophageal, paragastric, and paraduodenal access, histological specimens can be obtained from further lymph nodes using EUS-guided sampling [41,43,[45][46][47][48][49][50] [Figure 2a-m]. The most important differential diagnoses are metastases of malignant tumors, non-Hodgkin's and Hodgkin's disease and other infections.…”

“…Mediastinal lymph nodes can be biopsied using EUS-or EBUS-guided FNA or FNB. Via paraoesophageal, paragastric, and paraduodenal access, histological specimens can be obtained from further lymph nodes using EUS-guided sampling [41,43,[45][46][47][48][49][50] [Figure 2a-m The lymph nodes are visualized between the markers. In the EUS, paragastric lymph nodes are enlarged, rounded, very hypoechoic, with hypoechoic central parts, and forming conglomerates.…”

“…In 2022, two systematic reviews analyzed 133 and 311 cases of esophageal tuberculosis [94,95]. Esophageal tuberculosis is secondary to tuberculous mediastinal lymphadenopathy, which causes infiltration, ulcerations, bulging lesions, and narrowing of the esophageal wall [45,96]. Due to direct extending and spreading from infracarinal nodes, the middle third of the esophagus is usually affected [97,98].…”

Cheesy material on macroscopic on-site evaluation after endoscopic ultrasound-guided fine-needle biopsy: Don't miss the tuberculosis

“…It can precisely determine the characteristics of pancreatic lesions (size, vascular invasion, and calcifications) and the aspect of peripancreatic lymph nodes. Combined with EUS-FNB, it has become an excellent investigation to diagnose pancreatic lesions and has established a high accuracy for its use in pathologic diagnosing[ 13 , 14 ].…”

“…However, few studies have been published about EUS in pancreatic TB compared to other sites of TB[ 14 ]. In the EUS, it can appear as a solid mass or mixed solid cystic lesions, usually with hypoechoic or anechoic echotexture without vascular invasion[ 14 ]. Although vascular invasion has been reported in some cases of pancreatic TB, it cannot be used to confirm malignancy[ 9 ].…”