内窥镜检查在照顾和评估嗜酸性粒细胞性食管炎(EoE)患者中起着至关重要的作用。内窥镜检查对诊断至关重要,评估对治疗的反应,治疗食管狭窄,以及对组织学缓解患者的持续监测。迄今为止,尚未建立用于识别或分级EoE严重程度的侵入性较小的测试,而作为两者不可或缺的诊断内窥镜检查仍然是标准标准。可能还需要对EoE不良事件的患者进行治疗性内窥镜检查。特别是,在部分患者中,扩张对于治疗和减轻疾病进展可能是必要的,以减少进一步的纤维化和狭窄形成.使用修改后的Delphi共识过程,由20名EoE专家临床医师和研究者组成的研究小组为EoE内窥镜检查的使用提供指导.通过一个迭代过程,该小组就20份声明达成共识,就组织抽样标准提出全面建议,疾病活动的总体评估,内窥镜扩张的使用和性能,和疾病监测,尽管缺乏高质量的证据.当讨论无法就声明的优点达成协议时,就确定了争议的关键领域。我们预计,随着研究的进行,将获得更高质量的证据,以便为这些问题创建指南。我们进一步预计,即将到来的专家生成和商定的声明将为EoE患者的内窥镜检查的作用和使用提供有价值的实践建议。
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.