Esophageal lichen planus

  Gastroscopy

Esophageal lichen planus


Macroscopic Criteria and Grading

  1. Negative Endoscopy (N)
  • Criteria: None of the criteria below were fulfilled.
  • Possible signs: None.
  1. Stenosis/Strictures (S)
  • S1: Passable with an endoscope.
  • S2: Below 1 cm diameter; non-passable with an endoscope.
  1. Hyperkeratosis (H)
  • Criteria: White, rough mucosal surface.
  1. Trachealization (T)
  • Criteria: Tracheal-like appearance of the esophagus.
  1. Denudation of the Mucosa (D)
  • D0: No denudation.
  • D1: Iatrogenic denudation (sloughing and/or tearing of the mucosa after taking biopsies).
  • D2: Spontaneous, localized denudation (sloughing and/or tearing of the mucosa < 1 cm²).
  • D3: Spontaneous, extensive denudation (sloughing and/or tearing of the mucosa > 1 cm²).

Microscopic Criteria and Grading

  1. Histopathologic Criteria (HP)
  • Criteria:
    • Detachment of the epithelium (subepithelial/intraepithelial).
    • Lymphocytic (T-cell) infiltrate (subepithelial, junctional, intraepithelial).
    • Intraepithelial apoptosis (Civatte bodies).
    • Dyskeratosis.
  • Grading:
    • HP0: Negative.
    • HP1: Weak positive.
    • HP2: Positive.
    • HP3: Strong positive.
  1. Immunofluorescence Criteria (F)
  • Criteria:
    • Fibrinogen depositions along the basement membrane in direct immunofluorescence (DIF).
  • Grading:
    • F0: No visible reaction.
    • F1: Weak positive (some fibrinogen deposits visible).
    • F2: Positive (fibrinogen deposits clearly present along the basement membrane).
  • Other Depositions: IgG, IgA, or C3 were described but not included in the grading system.

Grading of Esophageal Lichen Planus (ELP)

  1. Severe ELP
  • Criteria:
    • Endoscopy: D2 (Spontaneous, localized denudation) and positive histopathology (≥ HP1).
    • Positive DIF may substitute for HP if HP grading is ambiguous.
  1. Mild ELP
  • Criteria:
    • Endoscopy D1 (Iatrogenic denudation) and positive histopathology (≥ HP1) and/or DIF (≥ F1).
    • Endoscopy N (Negative) or U (Unspecified) and positive histopathology (≥ HP1) and DIF (≥ F1).
  1. No ELP
  • Criteria: None of the above criteria were fulfilled.
esophageal lichen planus

References:

Franziska Schauer, Carmen Monasterio, Kristin Technau-Hafsi, Johannes
Steffen Kern, Adhara Lazaro, Peter Deibert, Peter Hasselblatt, Henning Schwacha, Steffen Heeg, Volker Brass, Armin Küllmer, Arthur Robert Schmidt, Annette Schmitt-Graeff & Wolfgang Kreisel. (2019) Esophageal lichen planus: towards diagnosis of an underdiagnosed disease, Scandinavian Journal of Gastroenterology, 54:10, 1189-1198, DOI: 10.1080/00365521.2019.1674375