The esophageal biopsy “pull” sign: a highly specific and treatment-responsive endoscopic finding in eosinophilic esophagitis (with video) - 02/06/16
Abstract |
Background and Aims |
Esophageal biopsy specimens from patients with eosinophilic esophagitis (EoE) can feel firm, with resistance felt when pulling the forceps to obtain the tissue sample. We aimed to assess the diagnostic utility of the esophageal biopsy “pull” sign and determine its histologic associations and response to treatment.
Methods |
This was a prospective cohort study of adults undergoing outpatient upper endoscopy. Cases of EoE were diagnosed per consensus guidelines, and patients were subsequently treated with either topical steroids or dietary elimination. Control subjects were individuals who did not have EoE. The frequency of the esophageal biopsy “pull” sign was assessed in EoE patients and controls, and diagnostic metrics were calculated. The “pull” sign was also reassessed in patients after therapy.
Results |
A total of 83 EoE patients and 121 control subjects were included. Sixty-three EoE patients (76%) were “pull” sign positive compared with just 2 control subjects (2%; P < .001), corresponding to a sensitivity and specificity of 76% and 98%, positive and negative predictive values of 97% and 86%, and positive and negative likelihood ratios of 45.9 and 0.245, respectively. The “pull” sign was the strongest endoscopic predictor of EoE case status at baseline and was less frequent after successful treatment (20% vs 79%; P < .001).
Conclusions |
The “pull” sign is highly specific for EoE and is rarely seen in non-EoE control subjects. In patients with EoE who respond to treatment, the “pull” sign often resolves. The “pull” sign may be a simple and easily obtained measure of esophageal remodeling.
Le texte complet de cet article est disponible en PDF.Abbreviations : CI, EoE, eos/hpf, LR, OR, PPI, PPI-REE
Plan
| DISCLOSURE: This work was supported, in part, by NIH Awards K23 DK090073 (E.S.D.) and K24DK100548 (N.J.S.), and uses resources from the UNC Center for GI Biology and Disease (P30 DK34987). All authors disclosed no financial relationships relevant to this article. |
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| If you would like to chat with an author of this article, you may contact Dr Dellon at edellon@med.unc.edu. |
Vol 83 - N° 1
P. 92-100 - janvier 2016 Retour au numéro
Article précédent
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