Endoscopic Diagnosis of Eosinophilic Esophagitis: Basics and Recent Advances

Abstract

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammatory disease, characterized by esophageal dysfunction and intense eosinophil infiltration localized in the esophagus. In recent decades, EoE has become a growing concern as a major cause of dysphagia and food impaction in adolescents and adults. EoE is a clinicopathological disease for which the histological demonstration of esophageal eosinophilia is essential for diagnosis. Therefore, the recognition of the characteristic endoscopic features with subsequent biopsy are critical for early definitive diagnosis and treatment, in order to prevent complications. Accumulating reports have revealed that EoE has several non-specific characteristic endoscopic findings, such as rings, furrows, white exudates, stricture/narrowing, edema, and crepe-paper esophagus. These findings were recently unified under the EoE endoscopic reference score (EREFS), which has been widely used as an objective, standard measurement for endoscopic EoE assessment. However, the diagnostic consistency of those findings among endoscopists is still inadequate, leading to underdiagnosis or misdiagnosis. Some endoscopic findings suggestive of EoE, such as multiple polypoid lesions, caterpillar sign, ankylosaurus back sign, and tug sign/pull sign, will aid the diagnosis. In addition, image-enhanced endoscopy represented by narrow band imaging, endocytoscopy, and artificial intelligence are expected to render endoscopic diagnosis more efficient and less invasive. This review focuses on suggestions for endoscopic assessment and biopsy, including recent advances in optical technology which may improve the diagnosis of EoE.

The Dual Lens of Endoscopy and Histology in the Diagnosis and Management of Eosinophilic Gastrointestinal Disorders—A Comprehensive Review

“…The recognition of these signs can be a critical juncture in diagnostic endoscopy, as they are indicative of potential eosinophilic infiltration, guiding the endoscopist to perform targeted biopsies. Recent advances in diagnostic endoscopic tools are paving the way for new era in EoE endoscopic assessment [77]. Virtual Chromoendoscopy (VC) techniques have enhanced endoscopic diagnostic performances in multiple settings [78].…”

Benralizumab treatment in an elderly patient with eosinophilic esophagitis resulted in remission: a case report

“…Adults with EoE experience dysphagia, reflux, chest discomfort, and pericardial pain; esophageal stenosis occurs with a decrease in esophageal lumen diameter due to pathological tissue remodeling [ 3 ]. Endoscopic findings in EoE frequently include white exudates, mucosal edema, linear furrows, esophageal rings, and stricture of esophageal mucosa [ 4 ]. EoE is common in Caucasian males, with worldwide prevalence rates ranging from 0.5 to 1 case per 1000, and annual incidence rates ranging from 5-10 new cases per 100,000 [ 5 ].…”

Eosinophilic Esophagitis among Patients with Refractory Gastroesophageal Reflux Disease

“…White exudates or plaques, concentric rings, linear furrows as well as friability, are all endoscopic findings in EoE. Serious illness is indicated by narrowing of the lumen and strictures (3) .…”