EoE ToT Module 5 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) hosted a consensus conference to discuss the role of endoscopy in diagnosing, treating, and managing eosinophilic esophagitis (EoE). A task force of 20 experts used a modified Delphi process to achieve consensus on 20 statements that guide endoscopic practice for EoE, despite limited high-quality evidence.<br /><br />Key Points:<br />1. **Diagnosis & Biopsy:** <br />   - EoE diagnosis requires at least six biopsy samples from various esophageal locations due to the disease's patchy nature.<br />   - Biopsies should be taken regardless of endoscopic appearance.<br /><br />2. **Endoscopic Grading:**<br />   - The Endoscopic Reference System (EREFS) should be routinely used to assess EoE activity based on five findings: edema, rings, exudates, furrows, and strictures.<br />   - Improvement in inflammatory features is a desired endpoint of therapy.<br /><br />3. **Therapeutic Endoscopy:**<br />   - Dilation is effective for treating esophageal strictures and improving symptoms, yet does not reduce mucosal eosinophilia.<br />   - A target esophageal diameter of 16mm or more, achieved over several sessions, is recommended to relieve dysphagia.<br />   - Dilation can be safe even for patients with active inflammation and fibrostensotic disease.<br />   - Control of esophageal inflammation attenuates the need for future dilation.<br /><br />4. **Monitoring Disease Activity:**<br />   - Regular monitoring of EoE patients is necessary as the disease is chronic and progressive.<br />   - Symptoms alone aren't sufficient; endoscopy and biopsies are needed to gauge disease remission accurately.<br />   - Experts emphasize ongoing clinical evaluations and possibly periodic endoscopic assessments for symptom-free patients.<br /><br />Expert insights emphasize the critical role of endoscopy in the accurate diagnosis, therapeutic intervention, and monitoring of disease activity in EoE patients. The Delphi process helped consolidate expert opinion into actionable guidelines to optimize the endoscopic management of EoE, highlighting dilations' effectiveness and safety, the value of comprehensive biopsying, and the utility of standardized assessment tools like EREFS. These guidelines aim to improve disease understanding and patient care while acknowledging the uncertainties and gaps that ongoing research must address.

Keywords

ASGE

endoscopy

eosinophilic esophagitis

EoE

biopsy

dilation

EREFS

Delphi process

diagnosis

therapeutic intervention