Current practice positions on oesophageal biopsy sampling and endoscopic dilation in adult patients with eosinophilic oesophagitis

Background There is a gap of knowledge with regards to the optimal biopsy sampling procedure as well as the technical and temporal aspects of endoscopic dilation for eosinophilic oesophagitis (EoE). Current guidelines lack specific recommendations. Methods The Swiss Network for Eosinophilic Gastrointestinal Diseases, together with members from The International Gastrointestinal Eosinophil Researchers, assembled a topical review consensus group. After a systematic literature review, two rounds of voting in a Delphi-style process were performed. Statements were rated on an even Likert scale ranging from 1 (strong disagreement) to 4 (strong agreement). Statements were accepted if they achieved an agreement of >80%. Results The experts agreed on a total of 10 statements, 5 statements about biopsy sampling and 5 statements about endoscopic dilation. There was agreement about the need for separately collecting biopsies from at least two segments of the oesophagus, standardised endoscopic and histological disease assessment and the optimal biopsy technique (one biopsy per attempt using the turn and suction technique). The experts further agreed on the early use of endoscopic dilation whenever fibrostenosis is present and an interval of 6–12 months between dilations in most cases. In the absence of fibrostenosis and dysphagia symptoms, empiric dilation for non-dysphagia symptoms cannot be recommended. Conclusion These current practice positions summarise the recommended approach to oesophageal biopsy sampling and endoscopic dilation in adult patients with EoE. Given the lack of randomised controlled data, the statements made in this topical review consensus are largely based on expert opinion and should be seen as guidance in clinical practice that will evolve in the future as newer data emerge.