TY - JOUR
T1 - Management of eosinophilic esophagitis associated food impaction in Europe and the United States
AU - Schreiner, Philipp
AU - Safroneeva, Ekaterina
AU - Schoepfer, Alain
AU - Greuter, Thomas
AU - Biedermann, Luc
AU - Schlag, Christoph
AU - Labenz, Joachim
AU - Auth, Marcus K.H.
AU - Bredenoord, Albert J.
AU - Chang, Joy W.
AU - Bonis, Peter A.
AU - Rothenberg, Marc E.
AU - Collins, Margaret H.
AU - Hirano, Ikuo
AU - Gupta, Sandeep K.
AU - Katzka, David A.
AU - Dellon, Evan S.
AU - Straumann, Alex
AU - Furuta, Glenn T.
AU - Gonsalves, Nirmala
N1 - Funding Information:
The study was supported by grants from the Swiss National Science Foundation (SNSF32473B-185008 [Ekaterina Safroneeva], 33CS30-177523/1 [AlainSchoepfer]) and the Swiss EoE foundation.
Publisher Copyright:
© 2022 The Author(s).
PY - 2022/9/1
Y1 - 2022/9/1
N2 - Eosinophilic esophagitis (EoE) is the most common cause of esophageal food impaction (EFI). Approaches to management of EFI due to EoE have not been well characterized. We conducted a web-based survey to understand approaches to management of EFI due to EoE among endoscopists. Questions focused on management of patients from presentation to post-endoscopy follow-up. The survey was administered to a list of eligible candidates provided by societies of gastroenterology. A total of 308 endoscopists completed the questionnaire. The majority (83%) practiced in Europe and treated adults (78%). Most agreed patients should be advised to seek emergency care (66%) within 1 to 2 hours (41% agreement). There was agreement that medications to induce vomiting should be avoided (84%) and that blood tests or imaging studies were usually not required before endoscopy. By contrast, there was more variability in the type of sedation recommended and the need for endotracheal intubation, especially when comparing more experienced with less experienced EoE-endoscopists. Overall, fewer than half (43%) respondents recommended obtaining esophageal biopsies during the initial endoscopy. However, there were significant differences in the proportion who recommended biopsies based on level of EoE-experience (25, 52, 77%, P < 0.001; less vs. moderate vs. very experienced) and comparing pediatric and adult endoscopists (32, vs. 79%, P < 0.001; adult vs. pediatric). There exists heterogeneity among endoscopists in recommendations to manage EFI in patients with EoE. These findings support development of clinical guidelines and new studies to clarify the rationale for best practices. Key summary: Established knowledge - The optimal management of patients with esophageal food impaction due to eosinophilic esophagitis from presentation at the emergency department to postendoscopy care is unclear. New findings - Considerable recommendation variation exists in the management of EFI in patients with EoE. Our findings provide a rationale for the creation of consensus practice guidelines and further study into best practices.
AB - Eosinophilic esophagitis (EoE) is the most common cause of esophageal food impaction (EFI). Approaches to management of EFI due to EoE have not been well characterized. We conducted a web-based survey to understand approaches to management of EFI due to EoE among endoscopists. Questions focused on management of patients from presentation to post-endoscopy follow-up. The survey was administered to a list of eligible candidates provided by societies of gastroenterology. A total of 308 endoscopists completed the questionnaire. The majority (83%) practiced in Europe and treated adults (78%). Most agreed patients should be advised to seek emergency care (66%) within 1 to 2 hours (41% agreement). There was agreement that medications to induce vomiting should be avoided (84%) and that blood tests or imaging studies were usually not required before endoscopy. By contrast, there was more variability in the type of sedation recommended and the need for endotracheal intubation, especially when comparing more experienced with less experienced EoE-endoscopists. Overall, fewer than half (43%) respondents recommended obtaining esophageal biopsies during the initial endoscopy. However, there were significant differences in the proportion who recommended biopsies based on level of EoE-experience (25, 52, 77%, P < 0.001; less vs. moderate vs. very experienced) and comparing pediatric and adult endoscopists (32, vs. 79%, P < 0.001; adult vs. pediatric). There exists heterogeneity among endoscopists in recommendations to manage EFI in patients with EoE. These findings support development of clinical guidelines and new studies to clarify the rationale for best practices. Key summary: Established knowledge - The optimal management of patients with esophageal food impaction due to eosinophilic esophagitis from presentation at the emergency department to postendoscopy care is unclear. New findings - Considerable recommendation variation exists in the management of EFI in patients with EoE. Our findings provide a rationale for the creation of consensus practice guidelines and further study into best practices.
KW - eosinophilic esophagitis
KW - esophageal food impaction
KW - esophagus
UR - http://www.scopus.com/inward/record.url?scp=85131625342&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85131625342&partnerID=8YFLogxK
U2 - 10.1093/dote/doac003
DO - 10.1093/dote/doac003
M3 - Article
C2 - 35088073
AN - SCOPUS:85131625342
SN - 1120-8694
VL - 35
JO - Diseases of the Esophagus
JF - Diseases of the Esophagus
IS - 9
M1 - doac003
ER -