New Guidelines From the ASGE for Diagnosis and Management of Eosinophilic Esophagitis

Question:

A 25-year- old patient presents with acute meat impaction. After removing the food bolus, would you biopsy to rule out eosinophilic esophagitis?

The new guidelines for the diagnosis and management for eosinophilic esophagitis are out. Let’s see what they say. I have prepared a list of key takeaways.

Answer to the above question:

Yes, biopsies during index endoscopy for removal of food impaction are recommended. Of course, removing a food impaction may be challenging and often, this procedure is done in the middle of the night and, in also unsedated patients. Thus, if the patient is feeling uncomfortable and has nausea and retching, prolonging the procedure to obtain enough biopsies may not be wise. However, a follow-up procedure to obtain biopsies is indicated.

Key Takeaways:

• Bx at index EGD (even if the EGD was done for food impaction) (see my comment)

• Obtain at least 6 biopsy samples, from the distal and mid/proximal esophagus

• Even if esophagus appears quite normal, if suspicious if EoE, biopsies are mandatory

• Use EREFS score - https://community.endocollab.com/posts/erefs-score-for-eosinophilic-esophagitis-eoe

• Response to therapy is based on endoscopy, thus repeated EGD is important, especially when adjusting medications or diet

• Dilation is important in the presence of dysphagia

• When dilating, the endpoints are mucosal laceration or disruption or reaching the target diameter

• Gradual and repeated dilations may be necessary to reach a target diameter of 16m.

For more information: Aceves S, et al.Endoscopic approach to eosinophilic esophagitis: American Society for Gastrointestinal Endoscopy Consensus Conference. Gastrointest Endosc 2022:96;576-592

https://www.giejournal.org/action/showPdf?pii=S0016-5107%2822%2901725-4

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