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. 2013 Dec 21;19(47):9034-42.
doi: 10.3748/wjg.v19.i47.9034.

Superficial esophageal lesions detected by endoscopic ultrasound enhanced with submucosal edema

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Superficial esophageal lesions detected by endoscopic ultrasound enhanced with submucosal edema

Jian-Jun Li et al. World J Gastroenterol. .

Abstract

Aim: To determine if there is consistency between endoscopic ultrasound (EUS) findings and pathological results for detecting lesions of different depth in the esophageal mucosa.

Methods: A canine (Beagle) model was established in which lesions of different depths were created in the esophageal mucosa by thermal burning. Seventy-two hours later, these lesions and adjacent tissue in the esophagus were examined by EUS. EUS findings including infiltrating depth, strength of echogenicity and homogeneity were recorded. Dogs were sacrificed and tissue specimens were obtained. We then compared the EUS findings with the pathology reports.

Results: Thermal burns created at different power settings caused lesions of different depth in the esophageal mucosa. When the echo strength was shifted from high, medium, to low echogenicity, an increase in the infiltrating depth of the lesion was noted, which coincided with results of the pathology examination. Obvious submucosal edema visualized by EUS was also detected by pathology. Furthermore, because of the enhancement caused by the submucosal edema, the lesions invading into the submucosa were easily visualized by EUS.

Conclusion: There is consistency between EUS findings and pathological results of esophageal lesions with different depths. Submucosal edema can serve as an ultrasonic contrast agent.

Keywords: Canine; Endoscopic ultrasound; Esophagus; Lesion; Pathology.

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Figures

Figure 1
Figure 1
Flow diagram of study protocol. EUS: Endoscopic ultrasonography; HFE: High frequency electro-coagulation generator.
Figure 2
Figure 2
Schematic diagrams of superficial lesions in the esophagus with different depths in a canine model.
Figure 3
Figure 3
Endoscopic ultrasonography and tissue examination of the normal esophagus in a beagle dog. A: The three layers of a normal esophagus, as visualized by endoscopic ultrasonography (EUS); B: Tissue examination showed that the esophageal wall is composed of the mucosa (including squamous epithelium, lamina propria, and muscularis mucosa), submucosa, and muscularis propria and adventitia.
Figure 4
Figure 4
Endoscopic ultrasonography and tissue examination of esophageal lesions located in the superficial mucosa (A, B) and deep mucosa (C, D). A, C: Endoscopic ultrasonography (EUS) imaging: high echoic lesions located in the mucosa (A) and relatively high echoic lesion (C) located in the mucosa with obvious submucosal edema, as visualized by EUS; B, D: Pathology: tissue examination showed that the lesions were located in the mucosa with complete (B) and incomplete (D) squamous epithelium, intact muscularis mucosa, and obvious submucosal edema.
Figure 5
Figure 5
Endoscopy, endoscopic ultrasonography, and tissue examination of an esophageal lesion invading into the submucosa (A, B) and muscularis propria (C, D). A, C: Endoscopic ultrasonography (EUS) imaging: Middle echoic lesion (A) and low echoic lesion (C) invading the submucosa with obvious submucosal edema, as visualized by EUS; B, D: Pathology: Lesion invading into the submucosa (B) and muscularis propria (D) was characterized as squamous epithelium with disappearing muscularis mucosa and submucosal edema, as revealed by pathological examination.

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