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Obtaining adequate lamina propria for subepithelial fibrosis evaluation in pediatric eosinophilic esophagitis
Jason Wang1, Jason Y Park2, Rong Huang3
1Department of Pathology, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Insights
Detecting subepithelial fibrosis in pediatric eosinophilic esophagitis (EoE) requires adequate esophageal biopsy specimens. Taking at least seven middle-distal esophageal biopsies increases fibrosis detection rates in children with EoE.
Area of Science:
- Gastroenterology
- Pediatric Pathology
- Histopathology
Background:
- Subepithelial fibrosis in eosinophilic esophagitis (EoE) is a key diagnostic marker.
- Accurate detection of fibrosis relies on biopsy specimens with sufficient lamina propria (LP).
Purpose of the Study:
- To determine the adequacy of pediatric esophageal biopsy specimens for detecting subepithelial fibrosis.
- To assess if esophageal eosinophilia affects LP acquisition rates.
- To establish optimal biopsy strategies for fibrosis detection in EoE.
Main Methods:
- Evaluation of 284 esophageal biopsy specimens from 39 EoE patients and 87 from 32 controls.
- Assessment for adequate lamina propria (LP) and subepithelial fibrosis.
- Analysis of LP acquisition rates and fibrosis detection based on biopsy location and number.
Main Results:
- No significant difference in adequate LP acquisition per specimen between EoE and non-EoE groups (43% vs 31%).
- Eighty-five percent of EoE patients exhibited fibrosis, often patchy and located in the middle/distal esophagus.
- Over 95% fibrosis detection probability achieved with 7 middle-distal esophageal biopsy specimens.
Conclusions:
- Individual pediatric esophageal biopsy specimens are frequently inadequate for fibrosis assessment.
- Similar LP acquisition rates in EoE and non-EoE patients necessitate a higher number of biopsies.
- At least 7 middle-distal esophageal biopsies are recommended for reliable fibrosis detection in EoE.
- Fibrosis may be an early finding in pediatric EoE, even with only inflammatory endoscopic features.
Background And Aims:
Subepithelial fibrosis in eosinophilic esophagitis (EoE) can be detected only in esophageal biopsy specimens with adequate amounts of lamina propria (LP). We investigated how often pediatric esophageal biopsy specimens contain adequate LP, and whether esophageal eosinophilia influences the acquisition rates.
Methods:
We evaluated 284 esophageal biopsy specimens from 39 patients with EoE, and 87 biopsy specimens from 32 patients without esophageal eosinophilia or other esophageal abnormalities for the presence of adequate LP and fibrosis.
Results:
On a per biopsy specimen basis, there was no significant difference in the rate of procuring adequate amounts of LP between patients with EoE and patients without esophageal eosinophilia (43% vs 31%, P = .14). Eighty-five percent of patients with EoE had fibrosis. Fibrosis in patients with EoE was patchy and more likely to be detected in the middle or distal esophagus (odds ratio, 19.93; 95% confidence interval, 4.12-91.52). Among patients with fibrosis, the probability of its detection reached >95% with 7 middle-distal esophageal biopsy specimens. Most children with newly diagnosed EoE already had subepithelial fibrosis despite exhibiting only inflammatory endoscopic features.
Conclusions:
Most individual esophageal biopsy specimens in children are inadequate for assessing subepithelial fibrosis, and the rates of procuring adequate LP per biopsy specimen are similar in patients with and without EoE. To reliably detect fibrosis in patients with EoE, at least 7 biopsy specimens should be taken from the middle-distal esophagus. The finding of fibrosis in children with newly diagnosed EoE and only inflammatory endoscopic features suggests that fibrosis can occur early in this disease.
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