Endoscopic ultrasonography in eosinophilic infiltration of gastric wall

The case of a young man with eosinophilic gastroenteritis with primary muscularis propria involvement in the antrum and distal ileum is presented. Initial diagnosis was based uniquely on indirect clinical and radiological findings since endoscopic and histologic data had been misled by the depth of eosinophilic infiltration. In order to directly prove the diagnosis, full-thickness operative biopsy would have been necessary but was avoided on ethical grounds. Valuable information was gained through Endoscopic Ultrasonographic (EUS) study of the antrum which showed an asymmetrical thickening of the outer hypoechoic layer of the wall corresponding to the muscularis propria. The overall thickness of the antrum amounted to 0.6 cm, clearly distinct from the 0.2 cm value in uninvolved areas. Subserosal involvement was also appreciated in spite of the absence of ascites; superficial layers, mucosa and submucosa, appeared uninvolved. The patient was restudied 6 months later when symptom-free: at this time, blood eosinophilia persisted and the EUS picture was unchanged. These observations suggest that peripheral blood eosinophilia along with eosinophilic infiltration of the gastric wall are stable conditions, unrelated to symptoms. Endoscopic ultrasonography is of value in ascertaining muscular involvement in eosinophilic gastroenteritis.