EoE ToT Module 5 References-Dellon ES Clin Gastroenterol Hepatol 2021 Optimizing the Endoscopic Examination in Eosinophilic Esophagitis

Dellon ES Clin Gastroenterol Hepatol 2021 Optimizing the Endoscopic Examination in Eosinophilic Esophagitis

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The article "Optimizing the Endoscopic Examination in Eosinophilic Esophagitis" by Evan S. Dellon focuses on enhancing the diagnostic and therapeutic efficacy of endoscopic procedures for eosinophilic esophagitis (EoE). With increasing EoE prevalence, clinicians must maintain a high suspicion during endoscopies. Statistics indicate that 6% of all upper endoscopy patients, 15% with dysphagia, and 50% with food impaction are diagnosed with EoE.<br /><br />A critical tool for assessing EoE is the EoE Endoscopic Reference Score (EREFS), which quantifies key features such as edema, rings, exudates, furrows, and strictures. Each feature is graded to generate a total score reflecting endoscopic disease severity and aiding in clinical assessments and treatment monitoring. <br /><br />The article outlines best practices for an optimal endoscopic examination in EoE. Clinicians should initially intubate the esophagus and proceed to the stomach to ensure safety before fully examining the esophagus, avoiding premature removal of exudates that could skew diagnosis. Thorough washing and suctioning of the mucosa and complete esophageal insufflation are vital for accurate assessment. Proper inflation helps distinguish between transient rings and fixed rings indicative of EoE.<br /><br />Identifying strictures or narrowing poses a challenge, primarily if they are less severe and not visually obvious. Endoscopists must be vigilant for signs of strictures at all esophageal locations and consider tactile sensations of resistance or "speed bumps" during scope passage. Balloon dilation can assist in confirming esophageal diameter and narrowing extent.<br /><br />For histologic assessment, obtaining multiple biopsies from at least two different esophageal locations increases diagnostic yield. Targeting specific EoE findings and avoiding normal-appearing subesophageal areas is recommended.<br /><br />The article concludes that meticulous endoscopic practices, including using EREFS, identifying strictures, and obtaining adequate biopsies, enhance diagnostic accuracy and treatment monitoring for EoE, ultimately improving patient care.

Keywords

Eosinophilic Esophagitis

Endoscopic Examination

EREFS

Edema

Rings

Exudates

Furrows

Strictures

Biopsies

Diagnostic Accuracy