ASGE Recognized Industry Associate (ARIA) Training Program for Regeneron and Sanofi | August 2024-Aceves 2022 Gastrointest Endosc

Aceves 2022 Gastrointest Endosc_ASGE Consensus

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The American Society for Gastrointestinal Endoscopy (ASGE) convened an expert panel to develop consensus guidelines on the endoscopic management of eosinophilic esophagitis (EoE). EoE is a chronic allergic inflammatory disease contributing to esophageal strictures and dysphagia, increasing significantly in incidence and prevalence across all age groups. Endoscopy remains critical for diagnosing EoE, monitoring treatment response, and managing complications like strictures.<br /><br />A group of 20 international experts in adult and pediatric gastroenterology, allergy, and therapeutic endoscopy used the modified Delphi method to generate and agree upon 20 consensus recommendations for endoscopic practices in diagnosing, grading, and treating EoE. Key recommendations include: <br /><br />1. **Endoscopic Diagnosis**: At least six biopsy samples should be taken from the distal and proximal esophagus for accurate diagnosis due to the patchy nature of the disease.<br /><br />2. **Endoscopic Grading**: The EoE Endoscopic Reference System (EREFS) should be routinely used during endoscopy to assess disease activity, focusing on common endoscopic findings like edema, rings, exudates, furrows, and strictures.<br /><br />3. **Assessing Response to Therapy**: Endoscopy and biopsy sampling, rather than symptoms alone, are essential for evaluating EoE's activity after treatment changes.<br /><br />4. **Endoscopic Dilation**: Dilation is recommended for patients with dysphagia due to esophageal strictures. The goal is to achieve an esophageal diameter of at least 16 mm over one or more sessions. Concomitant anti-inflammatory treatment is recommended to minimize the need for future dilation and manage dysphagia effectively.<br /><br />5. **Monitoring Disease**: Continued monitoring of patients in remission via symptoms and periodic endoscopy with biopsy sampling is advised.<br /><br />The guidelines emphasize the need for histologic remission to reduce the frequency of dilations and to manage inflammation that contributes to esophageal narrowing. The consensus aims to streamline and standardize the endoscopic management of EoE despite limited high-quality evidence, anticipating future studies to refine these practices further. <br /><br />These consensus statements provide a comprehensive framework for gastroenterologists and related specialists to improve patient outcomes in managing EoE, emphasizing diagnosis accuracy, effective treatment, and ongoing monitoring.

Keywords

ASGE

Eosinophilic Esophagitis

EoE

Endoscopic Management

Consensus Guidelines

Endoscopic Diagnosis

Endoscopic Grading

Therapeutic Endoscopy

Biopsy Sampling

Esophageal Strictures