I'm Sravanti Parasa, I'm a gastroenterologist in Seattle, and I work for a hospital called Swedish Medical Center. I think a high quality endoscopic exam is like a prerequisite for any endoscopy exam, right? So the first important thing is you need to have the right type of scope, so we emphasize that you have to have a high definition white light endoscopy. Make sure you don't have any bubbles or debris in the upper GI tract that you're trying to visualize. So that becomes very important, so cleansing and making sure you have a good mucosal surface that you can look at. And the third thing is once you clear that surface, making sure you're spending enough time to look for any abnormalities that you would want to, you know, rule in or rule out during your endoscopy. And that's basically the three main principles of a good high quality endoscopic exam. In the context of EOE, I think a lot of times when we advance the scope, we go in too fast where we miss strictures that, you know, are very subtle. They could be at your upper esophageal sphincter or at the GE junction, so careful examination and going through the esophagus multiple times to make that emphasis on trying to find those strictures or furrows, making sure there are no exudates, making sure there are no particulate matter. It becomes very important and trying to avoid missing lesions is the main concern. One of the reasons why we need to use an EREF is, you know, it's almost like a standardization of how you quantify the disease from an endoscopic standpoint. So let's say you have a patient that you've seen in the ER and you have some EREF score, you're following them back in repeat endoscopy and then you want to see there is a change based on the therapy or you started them on therapy, you need to track how they're doing from an endoscopic standpoint. So that becomes important. And of course, if you're not taking biopsies at the right places or we're not doing the technique right or we're not taking enough samples, that would obviously not give us the right diagnosis. So emphasizing on the biopsy technique, how to obtain those biopsies from your distal or mid and proximal esophagus, the number of biopsies that you need to take, and also trying to take biopsies from visually apparent areas which have like a stricture or a clear furrow or something would ease the diagnostic yield so that you can make an appropriate management plan and, you know, decision for the patient. When we talk about mimics, we are talking just about endoscopic mimics, right? So what we are seeing and what are the other conditions that affect the esophagus that look very much like a patient who has EOE. That's the differential diagnosis that we are thinking about and talking about those differentials as we are doing our biopsy protocol. And I just want to add that other than the diseases that we talk about in endoscopic mimics, a normal mucosa could be a mimic for EOE as well. I think if you are a trainer and you are looking to learn from this module, there are four important learning objectives. One is how you do a good quality, rather a high quality endoscopic exam. Two, what are the features or endoscopic findings based on the EREF score and how do you classify a patient into a certain category of the EREF score. Third is how you do the biopsy protocol for a patient on whom you suspect EOE or you are following a patient who has an established diagnosis of EOE. And the fourth point is what are disease conditions and differential diagnosis that you need to consider when you see patients who have eosinophilic esophagitis, those endoscopic findings, and what are those differential diagnosis that you need to consider. So those are the four important points that I would take as a trainer if you are using these slides. We hope you find value in these slides and talking about the different endoscopic features and what to look for when you're doing an endoscopy in a patient who has EOE. Please let us know if there are areas where we can improve, where your learning experience can be better, and any future questions that you may have for us. Thank you.

endoscopic exam

eosinophilic esophagitis

EREF score

biopsy techniques

differential diagnoses