Module 9 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 GIE ASGE Consensus Conference, conducted under the auspices of the American Society for Gastrointestinal Endoscopy, provided comprehensive guidance on the endoscopic management of eosinophilic esophagitis (EoE). The consensus involved 20 expert clinicians and investigators who employed a modified Delphi process to achieve consensus on 20 key statements, addressing various aspects of endoscopy in EoE.<br /><br />Endoscopy is crucial for diagnosing EoE, evaluating therapy response, treating esophageal strictures, and monitoring patients. Non-invasive methods have not yet proven reliable in diagnosing or grading EoE severity, making endoscopy the gold-standard. The panel recommended taking at least six biopsy samples from various parts of the esophagus to increase diagnostic sensitivity and advised that biopsies be taken even if the esophagus appears normal endoscopically.<br /><br />The EoE Endoscopic Reference System (EREFS) was recommended for routine assessment of disease activity and guiding treatment response. Endoscopic dilation was highlighted as essential for managing esophageal strictures and preventing disease progression. The group agreed on specific protocols for biopsy sampling, use of dilation techniques, and monitoring therapy response, indicating that endoscopy should be part of continuous monitoring even when patients are asymptomatic.<br /><br />Some areas of controversy were identified, including the optimal scoring criteria for remission and relapse, the use of baseline impedance planimetry, and the sufficiency of non-invasive monitoring methods like the sponge or string device. The consensus expressed the need for ongoing research to provide higher-quality evidence to refine these guidelines further.<br /><br />In conclusion, the consensus conference emphasized the indispensable role of endoscopy in the management of EoE, providing detailed guidance on biopsy sampling, disease activity assessment, therapeutic dilation, and monitoring strategies. The expert-generated statements aim to standardize endoscopic practices in EoE, ensuring better diagnosis, treatment, and long-term management of the disease.

Keywords

Eosinophilic Esophagitis

Endoscopy

ASGE

Consensus Conference

Biopsy Sampling

EREFS

Esophageal Strictures

Therapeutic Dilation

Non-Invasive Methods

Monitoring Strategies