EoE ToT Module 6 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) organized a consensus conference to address the role of endoscopy in managing eosinophilic esophagitis (EoE), a chronic allergic inflammatory condition increasingly prevalent in children and adults. The experts identified that endoscopy is vital for diagnosing EoE, guiding therapeutic responses, treating esophageal strictures, and monitoring disease in remission. The endoscopic approach is crucial due to the lack of less-invasive tests to fully assess EoE severity.<br /><br />The modified Delphi consensus method involved a panel of 20 international experts from various relevant medical fields, who assessed and agreed upon 20 key statements. These statements provide comprehensive guidelines on biopsy tissue sampling, assessing disease activity, performing endoscopic dilation, and monitoring EoE. Here are essential takeaways from the consensus:<br /><br />1. **Biopsy Sampling**:<br />   - At least six biopsy samples from different esophageal sections should be taken for diagnosing EoE.<br />   - Biopsies should target both distal and mid-/proximal esophagus regardless of endoscopic appearance to improve diagnostic sensitivity.<br /><br />2. **Endoscopic Grading**:<br />   - The Endoscopic Reference System (EREFS) should be used to assess EoE activity, including edema, rings, exudates, furrows, and strictures during endoscopy.<br />   - Improvement in inflammatory features (furrows, exudates, and edema) is a desired endpoint post-therapy.<br /><br />3. **Assessing Therapy Response**:<br />   - Endoscopy with biopsy sampling should be utilized to evaluate disease activity before and after changing dietary or pharmacologic treatment, rather than relying on symptoms alone.<br /><br />4. **Endoscopic Dilation**:<br />   - Dilation is considered safe and effective for patients with esophageal strictures and dysphagia. It should achieve a luminal diameter sufficient to alleviate symptoms, typically around 16 mm, and multiple sessions may be necessary.<br />   - Dilations should occur in conjunction with anti-inflammatory therapies to manage dysphagia and minimize stricturing.<br /><br />5. **Monitoring**:<br />   - Continued monitoring with periodic endoscopy and biopsy sampling, not just symptom tracking, is advisable for patients with EoE in remission.<br /><br />The experts acknowledged areas of controversy and data gaps, emphasizing the need for future studies to strengthen these guidelines. The results expect to provide valuable practice advice on the procedural use of endoscopy in EoE management.

Keywords

ASGE

eosinophilic esophagitis

endoscopy

biopsy sampling

EREFS

esophageal strictures

dilation

inflammatory features

therapy response

disease monitoring