Presidents:

Lee L. Swanström (USA-France)

Jie He (China)

Michio Hongo (Japan)

 

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Session 14

 

Sunday, September 3
2:00 – 4:00 pm

Room 4

 

 

Hot topics in esophageal pathology

 

Chairs: ILKe Nalbantoglu ( USA) – Maria Westerhoff (USA)

Discussants: Henry D. Appelman (USA) – Laura Rubbia-Brandt (Switzerland)

 

Eosinophilic esophagitis (EoE)

  • What is the rationale for the choice of 15 eosinophils per HPF as the cutoff for diagnosis?
  • How many biopsies are needed to exclude the diagnosis of EoE with confidence, and how big should they be?
  • What do degranulated eosinophils in the squamous epithelium mean in terms of diagnosis of EoE?
  • Is there any evidence that biopsies of endoscopically normal mucosa are cost effective in the diagnosis of EoE?
  • Is EoE with normal esophagus endoscopically the same as EoE with typical endoscopic findings?
  • Is it important to diagnose fibrosis of the lamina propria in EoE biopsies?

 

Lymphocytic esophagitis

  • In the absence of an esophageal motility disorder, does the histologic diagnosis of lymphocytic esophagitis have any clinical meaning?
  • In order to diagnose lymphocytic esophagitis, is it necessary that careful counts of intra-epithelial lymphocytes be performed?
  • Is lymphocytic esophagitis with the endoscopic appearance of EoE a specific disease?
  • What is the natural history of lymphocytic esophagitis?

Is reflux esophagitis ever a histologic diagnosis? A debate

                                                            Yes     --------------       No

Other inflammations

  • What drugs commonly induce endoscopic and histologic changes in the esophagus?
  • Is there an acute esophageal bacterial infection, and what does it look like in biopsies?
  • What are the histologic esophageal manifestations of dermatologic diseases?
  • What are the causes of sloughing esophagitis (esophagitis dessicans superficialis)?

 

Columnar topics

  • There is a 1.5 cm length of endoscopic columnar mucosa in the distal esophagus. Eight (8)  biopsies contain columnar mucosa that does not have a single goblet cell. In the UK, this is Barrett’s mucosa, but what is it in the US?
  • Pancreatic acinar cells are common in biopsies of the cardia. We refer to them as a metaplasia. What is the proof that they are metaplastic rather than simply being a normal variant?
  • Why, following injury such as reflux, is it necessary for metaplastic columnar mucosa to develop, and what is the purpose of the goblet cells?
  • Should all irregular Z-lines be biopsied in order to detect intestinal metaplasia?
  • What is the significance of intestinal metaplasia in the esophagus that is less than 1 cm long?

 

Unique case discussions

 

 







 

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