Division of Allergy, Immunology, Departments of Pediatrics and Medicine, University of California San Diego and Rady Children's Hospital, San Diego, California, USA.
Departments of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
Gastrointest Endosc. 2022 Oct;96(4):576-592.e1. doi: 10.1016/j.gie.2022.05.013. Epub 2022 Aug 11.
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.
内镜检查在诊治和评估嗜酸性粒细胞性食管炎（EoE）患者中起着关键作用。内镜检查对于诊断、评估治疗反应、治疗食管狭窄以及对组织学缓解患者的持续监测至关重要。迄今为止，尚未建立用于识别或分级 EoE 严重程度的非侵入性检查方法，而作为诊断的内镜检查仍然是标准。对于出现 EoE 不良事件的患者，可能也需要进行治疗性内镜检查。特别是在某些患者中，扩张术可能是治疗和减轻疾病进展所必需的，以最大限度地减少进一步纤维化和狭窄形成。通过使用改良 Delphi 共识过程，召集了一组 20 名 EoE 方面的专家临床医生和研究人员，为 EoE 内镜检查的应用提供指导。通过反复讨论，专家组就 20 项声明达成共识，就组织取样标准、疾病活动的大体评估、内镜扩张的使用和性能以及疾病监测提供了全面的建议，尽管缺乏高质量的证据。当讨论无法就某项声明的价值达成一致时，确定了关键的争议领域。我们预计，随着研究的不断进行，将获得更高质量的证据，从而为这些问题制定指南。我们进一步预计，即将出台的专家制定和达成一致的声明将为 EoE 患者内镜检查的作用和应用提供有价值的实践建议。
