EoE ToT Module 4 References-Aceves et al Gastrointest Endosc 2022 Endoscopic approach to eosinophilic esophagitis ASGE consensus conference PIIS0016510722017254

Aceves et al Gastrointest Endosc 2022 Endoscopic approach to eosinophilic esophagitis ASGE consensus conference PIIS0016510722017254

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The American Society for Gastrointestinal Endoscopy (ASGE) convened a consensus conference to address the endoscopic management of eosinophilic esophagitis (EoE), a chronic allergic disease of increasing prevalence. The experts underscored that endoscopy is crucial for diagnosing, assessing therapeutic response, treating esophageal strictures, and monitoring histologic remission in EoE. Despite the absence of less-invasive diagnostic methods, endoscopy remains the gold standard.<br /><br />A modified Delphi process, involving 20 EoE experts, resulted in consensus on 20 key statements. The guidance covers tissue sampling protocols, gross disease assessment, endoscopic dilation performance, and disease monitoring. Key findings include the recommendation of obtaining at least six biopsy samples from different esophageal locations for accurate diagnosis and mandatory biopsies regardless of endoscopic appearance, given that up to 32% of EoE patients may have normal endoscopic findings. The Endoscopic Reference System (EREFS) is vital for assessing disease activity based on edema, rings, exudates, furrows, and strictures.<br /><br />Endoscopic dilation is recommended for patients with esophageal strictures and dysphagia, aiming for a luminal diameter of at least 16mm, which may require multiple sessions. The experts emphasize that effective management of esophageal inflammation can reduce the necessity for future dilations. Dilation should be performed even in the presence of active inflammation, as it has been deemed safe with a low perforation risk.<br /><br />Periodic endoscopic evaluations are advised, even in symptom-free patients, to monitor disease remission and control inflammation. The process identifies areas needing further research to refine these guidelines.<br /><br />This consensus aims to provide comprehensive practice advice for gastroenterologists and other healthcare providers managing EoE, ensuring improved patient outcomes through standardized diagnostic and therapeutic endoscopic techniques.

Keywords

ASGE

eosinophilic esophagitis

endoscopy

diagnosis

biopsy

esophageal strictures

Delphi process

EREFS

dilation

disease monitoring