EoE Guidelines-Aceves et al Gastrointest Endosc 2022 Endoscopic approach to eosinophilic esophagitis ASGE consensus conference

Aceves et al Gastrointest Endosc 2022 Endoscopic approach to eosinophilic esophagitis ASGE consensus conference

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The American Society for Gastrointestinal Endoscopy (ASGE) has released a consensus on the endoscopic approach to eosinophilic esophagitis (EoE). This document, endorsed by the ASGE Governing Board, emphasizes the critical role of endoscopy in diagnosing, managing, and monitoring EoE. Key points include:<br /><br />1. **Endoscopy for Diagnosis**: Essential for initial diagnosis, assessing therapy response, and ongoing patient monitoring. Six biopsy samples are recommended from both the distal and mid-/proximal esophagus.<br />2. **Endoscopic Reference System (EREFS)**: Used to score common EoE features (edema, rings, exudates, furrows, and strictures), facilitating both diagnosis and monitoring.<br />3. **Therapeutic Endoscopy**: Dilation is a pivotal treatment for esophageal strictures and must be performed even in cases without clear visible signs but with clinical symptoms suggesting EoE.<br />4. **Consensus Statements**: Twenty statements were agreed upon using the Delphi method, covering tissue sampling, disease activity assessment, and treatment protocols. <br /><br />**Biopsy Recommendations**:<br />- Biopsies should be taken irrespective of endoscopic appearance due to the patchy nature of EoE.<br />- Index endoscopies for food impaction should include biopsies to avoid delays in diagnosis and treatment.<br /><br />**Endoscopic Grading**: <br />- Continuous monitoring of disease activity using EREFS is encouraged for assessing treatment efficacy.<br />- Improvements in inflammatory markers observed during follow-ups can validate treatment success.<br /><br />**Assessment and Monitoring**: <br />- Endoscopy with biopsy is crucial for assessing disease and should not rely on patient symptom reports alone due to their poor correlation with histologic findings.<br />- Persistent monitoring and management adjustments are recommended to control esophageal inflammation and reduce the need for repetitive dilation.<br /><br />**Dilation Protocol**:<br />- Ensure gradual dilation, potentially across multiple sessions, to reduce perforation risks.<br />- Regular dilation sessions may be needed, especially in patients without histologic remission despite medical therapy.<br /><br />**Safety of Dilation**:<br />- Dilation in patients with active inflammation can be done safely, although the protocol varies based on stricture characteristics.<br /><br />The document also acknowledges limitations due to a lack of high-quality evidence in some areas and aims to guide future research to develop comprehensive guidelines.

Keywords

ASGE

eosinophilic esophagitis

endoscopy

EREFS

biopsy

dilation

diagnosis

treatment

monitoring

consensus