EoE ToT Module 2 References-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) convened a consensus conference to establish guidelines on the endoscopic management of eosinophilic esophagitis (EoE). EoE is an increasing chronic type 2 allergic inflammatory disease observed in both children and adults, making endoscopy essential for diagnosis, therapy assessment, and ongoing monitoring. The consensus was reached using a modified Delphi process with 20 expert clinicians and investigators providing comprehensive guidance despite limited high-quality evidence.<br /><br />Key recommendations include:<br />- Biopsy sampling: At least six esophageal biopsies should be taken, particularly from the distal and mid/proximal esophagus, regardless of endoscopic appearance. This is crucial even if the initial presentation includes food impaction.<br />- Endoscopic grading: The EoE-specific Endoscopic Reference System (EREFS) should be routinely used for assessing disease activity, and improvements in inflammatory features should be a desired endpoint of therapy.<br />- Assessing response to therapy: Endoscopy and biopsy should be employed to evaluate the efficacy of dietary or pharmacologic treatment, as symptoms alone are not reliable.<br />- Endoscopic dilation: It is recommended for all patients with EoE and esophageal stricture with dysphagia to undergo dilation. The target luminal diameter should be around 16 mm and may require gradual dilation over multiple sessions to mitigate the risk of perforation.<br />- Monitoring disease: For patients in remission, periodic evaluations with endoscopy and biopsy are advised.<br /><br />The consensus highlights the use of endoscopy in various stages of EoE treatment, emphasizing the importance of a standardized approach in managing this complex condition. Statements that didn’t achieve consensus included the use of a sponge or string device for monitoring and the need for esophageal stenting in cases of perforation.<br /><br />Overall, this document is expected to guide clinical practices and improve patient outcomes until higher-quality evidence allows for more definitive guidelines.

Keywords

ASGE

eosinophilic esophagitis

endoscopy

biopsy sampling

EREFS

therapy assessment

endoscopic dilation

disease monitoring

consensus guidelines

Delphi process