Endoscopic Ultrasonography in Children with Eosinophilic Esophagitis-A Review

Diagnosis and Management of Long-term Gastrointestinal Complications in Pediatric Esophageal Atresia/Tracheoesophageal Fistula

PURPOSE OF REVIEW

Esophageal atresia/tracheoesophageal fistula (EA/TEF) causes gastrointestinal (GI) complications that can begin in infancy and extend into adulthood. The etiology of these is frequently multifactorial, and they can adversely affect feeding, growth, respiratory health, and overall quality of life. This review highlights the importance of early diagnosis, multidisciplinary surveillance, and individualized treatment strategies to effectively manage these complications and improve long-term outcomes for affected children.

RECENT FINDINGS

Recent studies have focused on the development of evidence-based surveillance protocols to optimally manage the numerous observed EA/TEF-associated digestive complications. Many of these complications stem from the combination of gastroesophageal dysmotility and mechanical obstruction inherent to EA/TEF and its surgical management, and include gastroesophageal reflux disease, feeding difficulties, dysphagia, eosinophilic esophagitis, and pulmonary consequences of aspiration. Management of GI complications in children with EA/TEF requires careful, multidisciplinary evaluation and treatment, incorporating dietary modifications, feeding therapy, pharmacotherapy, and surgical and endoscopic interventions.

EUS in children with eosinophilic oesophagitis - a new method of measuring oesophageal total wall thickness area. An artificial intelligence application feasibility study. A pilot study

Aim

In the study, we aimed to introduce a formula for measuring the oesophageal total wall thickness area, which could be used for developing an artificial intelligence-based algorithm for the detection of patients whose total wall thickness area exceeds the norms.

Material and methods

Mathematical formulas for measuring the square area of the oesophageal total wall thickness area were introduced and applied. Children were grouped according to their weight in clusters. For each cluster, the range (minimal and maximal value) were established. The measurements were done by using the formula for the area of the circular ring according to the formula A = n (B2-b2); the product of n and subtraction square b (smaller radius) and square B (bigger radius). The basic data for our calculations were derived from papers published by Dalby et al., 2010 and Loff et al., 2022.

Results

The square area (in mm2) of the oesophageal wall was calculated and proposed to be introduced for further analysis. This value set could be used for creating an algorithm for computer-aided analysis of patients diagnosed with sonographic examination and isolating patients for surveillance. Our newly introduced approach could be implemented in sonographic, computer tomography, and magnetic resonance examinations in eosinophilic oesophagitis and other oesophageal diseases.

Conclusions

Total wall thickness area could be used for monitoring children with eosinophilic oesophagitis and other oesophageal diseases. The method could also be applied for adults. Therefore, it can be a foundation for further progress with applying artificial intelligence algorithms.

Manometric findings in children with eosinophilic esophagitis and persistent post-remission dysphagia

Objectives

Dysphagia is a frequent symptom of active eosinophilic esophagitis (EoE), but at times it persists despite attaining histologic healing and lack of fibro-stenotic changes. We aimed to describe the manometric findings in this subset of patients.

Methods

A retrospective review of charts between 2013 and 2023 at a tertiary pediatric gastroenterology center, treating roughly 1500 EoE patients per year. We included children with EoE referred to high-resolution impedance manometry (HRIM) for persistent dysphagia despite histologic healing (i.e., <15 eosinophils/high-power field [Eos/hpf]). Data including initial EoE diagnosis, endoscopy reports, esophageal biopsies, treatment regimens, and HRIM were retrospectively collected.

Results

The estimated prevalence of post-remission dysphagia in our cohort was exceedingly rare (<0.05%). Four patients met the eligibility criteria of histologic remission and absence of fibro-stenotic features on endoscopic evaluation and thus, were included in this case series. Patients achieved remission with steroids, proton-pump inhibitor, or both within a median time of 5 months from diagnosis. Peak Eosinophil count at remission was ≤5 Eos/hpf in three patients and ≤10 Eos/hpf in one. On HRIM, all four patients had a hypomotile esophagus and abnormal bolus clearance. Lower esophageal sphincter integrated relaxation pressure values were normal in three patients and elevated in one. Two patients were diagnosed with ineffective esophageal motility, one with aperistalsis and one with achalasia type 1.

Conclusions

Post-remission dysphagia is rare in EoE. Esophageal dysmotility with a hypomotile pattern may contribute to the persistent dysphagia in children with EoE. HRIM should be considered in patients with EoE in whom symptoms persist despite histologic remission.

Endoscopy in Pediatric Eosinophilic Esophagitis

Eosinophilic esophagitis (EoE) is a chronic allergen-mediated clinicopathologic condition that currently requires esophagogastroduodenoscopy with biopsies and histologic evaluation to diagnose and monitor its progress. This state-of-the art review outlines the pathophysiology of EoE, reviews the application of endoscopy as a diagnostic and therapeutic tool, and discusses potential complications related to therapeutic endoscopic interventions. It also introduces recent innovations that can enhance the endoscopist's ability to diagnose and monitor EoE with minimally invasive procedures and perform therapeutic maneuvers more safely and effectively.