Abstract
Endoscopy plays a critical role in caring for and evaluating the patient with eosinophilic esophagitis (EoE). Endoscopy is essential for diagnosis, assessment of response to therapy, treatment of esophageal strictures, and ongoing monitoring of patients in histologic remission. To date, less-invasive testing for identifying or grading EoE severity has not been established, whereas diagnostic endoscopy as integral to both remains the criterion standard. Therapeutic endoscopy in patients with adverse events of EoE may also be required. In particular, dilation may be essential to treat and attenuate progression of the disease in select patients to minimize further fibrosis and stricture formation. Using a modified Delphi consensus process, a group of 20 expert clinicians and investigators in EoE were assembled to provide guidance for the use of endoscopy in EoE. Through an iterative process, the group achieved consensus on 20 statements yielding comprehensive advice on tissue-sampling standards, gross assessment of disease activity, use and performance of endoscopic dilation, and monitoring of disease, despite an absence of high-quality evidence. Key areas of controversy were identified when discussions yielded an inability to reach agreement on the merit of a statement. We expect that with ongoing research, higher-quality evidence will be obtained to enable creation of a guideline for these issues. We further anticipate that forthcoming expert-generated and agreed-on statements will provide valuable practice advice on the role and use of endoscopy in patients with EoE.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 576-592.e1 |
| Journal | Gastrointestinal endoscopy |
| Volume | 96 |
| Issue number | 4 |
| DOIs | |
| State | Published - Oct 2022 |
Funding
We are grateful to Dr Jenifer Lightdale, Dr Jennifer Christie, and Dr Emad Qayed for their review of this document. The following authors disclosed financial relationships: S. S. Aceves: Consultant for DBV and AstraZeneca; educational speaker for Medscape and Regeneron-Sanofi; grant funding from National Institutes of Health/National Institute of Allergy and Infectious Diseases/National Institute of Diabetes and Digestive and Kidney Diseases; co-inventor of oral viscous budesonide, University of California San Diego–patented Takeda license. J. A. Alexander: Consultant for Lucid Technologies; stockholder of Meritage Pharmacia; grant funding from Regeneron Pharmaceuticals. T. H. Baron: Consultant for Boston Scientific Corporation, CONMED Corporation, Medtronic, Olympus, and WL Gore & Associates, Inc. A. J. Bredenoord: Consultant for AstraZeneca AB, Celgene Corporation, Laborie Medical Technologies Corp, Medtronic USA, Inc, and Regeneron Pharmaceuticals. L. Day: Stockholder in 3T Biosciences and Pfizer; expert witness for Boehringer Ingelheim. E. S. Dellon: Consultant for Abbott Nutrition, AbbVie, Adare Pharmaceuticals, Aimmune, Allakos, Amgen, Arena, AstraZeneca, Avir, Biorasi, Calypso, Celgene Corporation, Celldex Therapeutics, Eli Lilly and Company, EsoCap, GlaxoSmithKline, Gossamer Bio, Landos, LucidDx, Morphic, Nutricia Research Foundation, Paraxel, Phathom, Regeneron Pharmaceuticals, Revolo, Robarts Clinical Trials, Salix, Sanofi US Services Inc, and Takeda. G. W. Falk: Consultant for Adare Pharmaceuticals, Allakos, Bristol-Myers Squibb, CDx, Cernostics, Interspace Diagnostics, Phathom, and Takeda California, Inc; grant recipient from Adare Pharmaceuticals, Allakos, Arena, Bristol-Myers Squibb, Interspace Diagnostics, Lucid, and Regeneron Pharmaceuticals; stockholder in Bristol-Myers Squibb; data and safety monitoring board for Revolo. G. T. Furuta: Consultant for Takeda; research funding from Holoclara, Arena, and National Institutes of Health; founder of EnteroTrack, LLC. N. Gonsalves: Consultant for AbbVie, Allakos, AstraZeneca, Knopp Biosciences, Nutricia Research Foundation, Sanofi Pasteur Biologics, LLC, and Regeneron-Sanofi; speaker for Takeda; royalties from Up-to-Date. I. Hirano: Consultant for Adare Pharmaceuticals, Allakos, Amgen, Arena, AstraZeneca, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Ellodi Pharmaceuticals, EsoCap, Gossamer Bio, Parexel/Calyx, Phathom, Receptos, Regeneron Pharmaceuticals, Sanofi, and Takeda; research funding from Adare Pharmaceuticals, Allakos, Arena, AstraZeneca, Bristol-Myers Squibb, Celgene, Meritage, Receptos, Regeneron-Sanofi, and Takeda. V. J. A. Konda: Consultant for Ambu, Cernostics, Exact Sciences, and Medtronic; research funding from Lucid. A. J. Lucendo: Consultant for Dr Falk Pharma and EsoCap; research funding from Adare Pharmaceuticals, Ellodi Pharmaceuticals, Dr Falk Pharma, and Regeneron Pharmaceuticals. F. Moawad: Consultant for Sanofi US Services, Inc and Takeda California, Inc. K. A. Peterson: Consultant for Alladapt, Allakos, AstraZeneca, Celgene, Ellodi Pharmaceuticals, Lucid, Medscape, Regeneron-Sanofi, Takeda; equity in Nexeos; intellectual property rights in patents for eosinophil granule proteins and methods for diagnosing and monitoring eosinophilic esophagitis. A. M. Schoepfer: Consultant for Abbvie, AstraZeneca, Bristol-Myers Squibb, Dr Falk Pharma, MSD, Sanofi-Genzyme, Takeda, Tillotts, UCB, and Viatris; research funding from AstraZeneca, Bristol-Myers Squibb, Dr Falk Pharma, Sanofi-Genzyme, and Swiss National Science Foundation. P. Sharma: Consultant for Boston Scientific Corporation, Fujifilm Medical Systems USA, Lumendi, Medtronic, Olympus, and Salix; grant recipient from CDx Labs, Cosmo Pharmaceuticals, Docbot, Erbe USA, and Ironwood Pharmaceuticals. D. A. Katzka: Consultant for Regeneron Pharmaceuticals and Takeda. All other authors disclosed no financial relationships. Supported by an educational grant from Takeda Pharmaceuticals U.S.A., Inc.
ASJC Scopus subject areas
- Gastroenterology
- Radiology Nuclear Medicine and imaging