UEG Week 2025: Relive the Highlights

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Introduction

Eosinophilic oesophagitis (EoE) is a disease that presents specific endoscopic findings. However, some patients with EOE do not show typical endoscopic findings (H. P. Kim. et. al., Clinical Gastro Hepatol 2012). Therefore, endoscopic findings are inadequate to diagnose EoE in such cases.

Aims & Methods

This retrospective cohort study sought to clarify the characteristics of patients with EoE without typical endoscopic findings of EoE. A total of 176 patients who underwent oesophagogastroduodenoscopy (OGD) with at least two oesophageal mucosal biopsies between March 2009 and December 2019 were reviewed. Oesophageal biopsy was performed due to typical endoscopic findings of EoE or symptoms suggestive of EoE. Patients with a history of achalasia and oesophageal surgery were excluded. We divided the pathologically diagnosed EoE patients (23 patients: 15 males, mean age = 47.4 years) into patients with typical endoscopic EoE (Positive group) and patients without endoscopic EoE (Negative group). Specific endoscopic findings of EoE were defined as either of four findings (oesophageal rings, longitudinal furrows, exudates, and strictures). Patients with at least one finding were classified into the Positive group. Symptoms, blood eosinophil count, eosinophil number in oesophageal mucosa, oesophageal motility, and treatment were reviewed. High resolution manometry (HRM) (ManoScan, Medtronic, MN, USA) was performed for 21 patients and evaluated using Chicago Classification v3.0.

Results

Typical endoscopic findings of EoE were shown in 17 patients(oesophageal rings:88%, longitudinal furrows:76%, exudates:47%, and strictures:6%). Six (26%) patients were classified into the Negative group. No differences in age, sex, mucosal eosinophil count, or blood eosinophil count were observed between the two groups. Patients in the Negative group presented chest pain more frequently than those in the Positive group (66.7% vs. 23.5%, p=0.03). HRM revealed oesophageal motility disorders in nine (47%) and five (83%) patients in the Positive and Negative groups, respectively, without significant difference. All patients received proton pump inhibitors or potassium-competitive acid blockers. The frequency of steroid therapy was not significantly different between both groups (18% in the Positive group vs. 50% in the Negative group, p=0.27.

Table:Patients’ demographics and clinical features of endoscopy negative and positive patients with EoE

		Endoscopy negative n=6	Endoscopy positive n=17
Age, y		47.3±62.6	50.8±13.4
Sex, M:F		2:4	13:4
Blood eosinophil counts, /µl [range]		300 [150-780]	360 [50-1220]
Maximam eosinophil count in oesophagus, /HPF [range]		59.5 [15-150]	45 [18-200]
Oesophageal motility disorders	EGJ outflow obstruction	2 (29%)	1 (7%)
	Jackhammer oesophagus	1 (14%)	3 (20%)
	Ineffective oesophageal motility	3 (43%)	3 (20%)
Treatment	PPI/P-CAB	6 (100%)	17 (100%)
	Steroid	3 (50%)	3 (18%)

PPI: proton pump inhibitor, P-CAB: potassium-competitive acid blocker

Conclusion

No apparent differences in severity of eosinophil infiltration, frequency of oesophageal motility disorder, or treatment were observed between both groups. A biopsy can be recommended for patients with symptoms of unexplained etiology, even in patients without specific endoscopic findings of EoE.

References

1. Kim HP, Vance RB, Shaheen NJ, Dellon ES. The prevalence and diagnostic utility of endoscopic features of eosinophilic esophagitis: a meta-analysis. Clin Gastroenterol Hepatol. 2012;10(9):988-96.e5.

Disclosure

All authors have declared no conflict of interest.

CHARACTERISTICS OF PATIENTS WITH EOSINOPHILIC OESOPHAGITIS WITHOUT TYPICAL ENDOSCOPIC FINDINGS OF EOSINOPHILIC OESOPHAGITIS

Hiroko Hosaka 1, Shiko Kuribayashi 1, Syota Tomaru 1, Yuki Itoi 1, Keigo Sato 1, Yu Hashimoto 1, Hirohito Tanaka 1, Yoji Takeuchi 1, Toshio Uraoka 1

1 Gunma University Graduate School of Medicine, Maebashi, Japan

Conference

UEG Week Copenhagen 2023

Topics

Oesophagus

Submission format

Abstract

Session

All about EoE (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

UEG Podcast Episode

Journal Podcast

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Gallstone Disease Relapse: Insights from the RELAPSTONE Study

Ahsen Ustaoglu 1, Raul Velamazan Sandalinas 2

1 Early Cancer Institute, University of Cambridge, United Kingdom

2 Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain

Topics

Pancreas

Published

2024

UEG Podcast Episode

UEG Podcast

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Best practises for caring for LGBTQ+ people in GI with Alexander Goldowsky (rewind)

Published

2025

UEG Standards and Guidelines

Clinical Practice Guideline

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Main recommendations

1 ESGE recommends endoscopic ultrasonography (EUS) as the best tool to characterize subepithelial lesion (SEL) features (size, location, originating layer, echogenicity, shape), but EUS alone is not able to distinguish among all types of SEL.
Strong recommendation, moderate quality evidence

2 ESGE suggests providing tissue diagnosis for all SELs with features suggestive of gastrointestinal stromal tumor (GIST) if they are of size > 20 mm, or have high risk stigmata, or require surgical resection or oncological treatment.
Weak recommendation, very low quality evidence

3 ESGE recommends EUS-guided fine-needle biopsy (EUS-FNB) or mucosal incision-assisted biopsy (MIAB) equally for tissue diagnosis of SELs ≥ 20 mm in size.
Strong recommendation, moderate quality evidence

4 ESGE recommends against surveillance of asymptomatic gastrointestinal (GI) tract leiomyomas, lipomas, heterotopic pancreas, granular cell tumors, schwannomas, and glomus tumors, if the diagnosis is clear.
Strong recommendation, moderate quality evidence

5 ESGE suggests surveillance of asymptomatic esophageal and gastric SELs without definite diagnosis, with esophagogastroduodenoscopy (EGD) at 3–6 months, and then at 2–3-year intervals for lesions < 10 mm in size, and at 1–2-year intervals for lesions 10–20 mm in size. For asymptomatic SELs > 20 mm in size that are not resected, ESGE suggests surveillance with EGD plus EUS at 6 months and then at 6–12-month intervals.
Weak recommendation, very low quality evidence

6 ESGE recommends endoscopic resection for type 1 gastric neuroendocrine neoplasms (g-NENs) if they grow larger than 10 mm. The choice of resection technique should depend on size, depth of invasion, and location in the stomach.
Strong recommendation, low quality evidence

7 ESGE suggests considering removal of histologically proven gastric GISTs smaller than 20 mm as an alternative to surveillance. The decision to resect should be discussed in a multidisciplinary meeting. The choice of technique should depend on size, location, and local expertise.
Weak recommendation, very low quality evidence

8 ESGE suggests that, to avoid unnecessary follow-up, endoscopic resection is an option for gastric SELs smaller than 20 mm and of unknown histology after failure of attempts to obtain diagnosis.
Weak recommendation, very low quality evidence

9 ESGE recommends basing the surveillance strategy on the type and completeness of resection. After curative resection of benign SELs no follow-up is advised, except for type 1 gastric NEN for which surveillance at 1–2 years is advised.
Strong recommendation, low quality evidence

10 For lower or upper GI NEN with a positive or indeterminate margin, ESGE recommends repeating endoscopy at 3–6 months and another attempt at endoscopic resection in the case of residual disease.
Strong recommendation, low quality evidence

Endoscopic management of subepithelial lesions including neuroendocrine neoplasms: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Pierre Henri Deprez

Publisher

European Society of Gastrointestinal Endoscopy

Guideline

Clinical Practice Guideline

Topics

Endoscopy

Citation

Endoscopy 2022; 54(04): 412-429

Published

2022

UEG Podcast Episode

Journal Podcast

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Are we providing the correct pancreatic enzyme treatment in chronic pancreatitis?

Iago Rodríguez-Lago 1, Friedemann Erchinger 2

1 Hospital Universitario de Galdakao, Bilbao, Spain

2 Kanalspesialistene AS, Bergen, Norway

Topics

Pancreas

Published

2023

UEG Standards and Guidelines

Clinical Practice Guideline

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Main recommendations

Malignant disease

1 ESGE recommends placement of partially or fully covered self-expandable metal stents (SEMSs) for palliation of malignant dysphagia over laser therapy, photodynamic therapy, and esophageal bypass.

Strong recommendation, high quality evidence.

2 ESGE recommends brachytherapy as a valid alternative, alone or in addition to stenting, in esophageal cancer patients with malignant dysphagia and expected longer life expectancy.

Strong recommendation, high quality evidence.

3 ESGE recommends esophageal SEMS placement for sealing malignant tracheoesophageal or bronchoesophageal fistulas.

Strong recommendation, low quality evidence.

4 ESGE does not recommend SEMS placement as a bridge to surgery or before preoperative chemoradiotherapy because it is associated with a high incidence of adverse events. Other options such as feeding tube placement are preferable.

Strong recommendation, low quality evidence.

Benign disease

5 ESGE recommends against the use of SEMSs as first-line therapy for the management of benign esophageal strictures because of the potential for adverse events, the availability of alternative therapies, and their cost.

Strong recommendation, low quality evidence.

6 ESGE suggests consideration of temporary placement of self-expandable stents for refractory benign esophageal strictures.

Weak recommendation, moderate quality evidence.

7 ESGE suggests that fully covered SEMSs be preferred over partially covered SEMSs for the treatment of refractory benign esophageal strictures because of their very low risk of embedment and ease of removability.

Weak recommendation, low quality evidence.

8 ESGE recommends the stent-in-stent technique to remove partially covered SEMSs that are embedded in the esophageal wall.

Strong recommendation, low quality evidence.

9 ESGE recommends that temporary stent placement can be considered for the treatment of leaks, fistulas, and perforations. No specific type of stent can be recommended, and the duration of stenting should be individualized.

Strong recommendation, low quality of evidence.

10 ESGE recommends considering placement of a fully covered large-diameter SEMS for the treatment of esophageal variceal bleeding refractory to medical, endoscopic, and/or radiological therapy, or as initial therapy for patients with massive bleeding.

Strong recommendation, moderate quality evidence.