# Case Report: Endoscopic ultrasound-guided fine-needle biopsy for the diagnosis of esophageal tuberculosis

## TL;DR

This case report shows that endoscopic ultrasound-guided fine-needle biopsy is effective in diagnosing esophageal tuberculosis, helping to distinguish it from other esophageal diseases.

## Contribution

The study highlights the diagnostic value of EUS-FNB in confirming esophageal tuberculosis through tissue sampling.

## Key findings

- EUS-FNB provided a pathological diagnosis of tuberculosis in four out of six cases.
- Esophageal tuberculosis was most commonly located in the middle of the esophagus.
- EUS-FNB helped differentiate tuberculosis from esophageal carcinoma and leiomyoma.

## Abstract

To summarise the characteristics of esophageal tuberculosis, and to evaluate the role of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) in the diagnosis of esophageal tuberculosis.

A retrospective analysis of esophageal tuberculosis patients diagnosed by the EUS-FNB between May 2012 and August 2023 was reported. Final diagnosis was based on histopathology, clinical context in combination with response to antitubercular therapy. Tissue acquisition of both esophageal lesions and enlarged mediastinal lymph nodes was performed by EUS-FNB. The variables evaluated were clinical features, location and diameter of the esophageal lesions and enlarged lymph nodes.

Six esophageal tuberculosis patients without surgical management were finally identified by the performance of EUS-FNB. The most common clinical feature was progressive dysphagia. The site of lesions was most common located in the middle of esophagus (66.7%). Diameter of lesions range from 1.2 to 4.1 cm. Multiple enlarged mediastinal lymph nodes were of various sizes (range 0.6–1.6 cm in diameter). CT scan revealed focal thickened esophageal wall, esophageal stenosis, and a mass with moderate and heterogeneous enhancement in five patients (83.33%), which indicating esophageal carcinoma. Purified protein derivative (PPD) and T cell spot test (T-spot) were positive in four cases (66.7%), which were significant in the diagnosis. EUS-FNB provided the pathological diagnosis of tuberculosis in four cases.

Esophageal tuberculosis should be distinguished from advanced esophageal carcinoma and leiomyoma. Moreover, EUS-FNB is an excellent method in both image and tissue biopsy to establish an accurate diagnosis of esophageal tuberculosis.