Esophageal perforation in eosinophilic esophagitis: A systematic review on clinical presentation, management and outcomes

Arias-González, Laura; Rey-Iborra, Esther; Ruiz-Ponce, M.; Laserna-Mendieta, Emilio J; Arias, Ángel; Lucendo, Alfredo J.

doi:10.1016/j.dld.2019.10.019

Cited by 27 publications

(25 citation statements)

References 78 publications

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“…1 Progressive or long-lasting pain in the event of food impaction as well as active and untreated esophageal inflammation are associated with esophageal perforation. 2 Taken together, our case underlines the importance of a consistent treatment and close follow-up of patients with EoE, specifically in those with long-standing and pronounced stricture formation. Albeit rare, esophageal food impaction may evolve into a life-threatening condition with mediastinitis and cardiac arrest due to esophageal perforation.…”

Section: Answer To Image (Page 42): Esophageal Perforation In the Mid Esophagus With Mediastinitis In Long-standing Eoe With Stricture Fosupporting

confidence: 59%

Defer No Time, Delays Have Dangerous Ends (William Shakespeare)

Biedermann

Hrúz²

2021

Gastroenterology

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Question: A 22-year-old man was diagnosed with eosinophilic esophagitis (EoE) at the age of 9 years in 2007. Already on initial endoscopic presentation, severe stricture formation was described requiring bougie dilation (3 sessions within the first 6 months). Subsequently, treatment with swallowed topical steroids was initiated. After having achieved clinical remission, the patient stopped therapy after 6 months. However, 2 months after withdrawal of steroids, the patient developed a clinical, endoscopic, and histological relapse. Subsequently, the patient was lost to further follow-up, engaging in a sporadic, symptom-guided, and self-directed topical steroid treatment. After almost 10 years without any endoscopic assessment of the disease state, the last endoscopic follow-up antecedent to the current presentation 1 year ago revealed active EoE with edema, furrows, and white exudates (Figure A), with long stricture formation in the mid and distal esophagus. The latter precluded passage with a standard gastroscope (outer diameter 9.9 mm), requiring guidewire placement for subsequent dilation to 9 mm using a nasal endoscope (large mucosal tear; Figure B). Histology revealed typical EoE characteristics, including eosinophilic abscesses (arrow: proximal esophagus; Figure C). Subsequently topical

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Section: Answer To Image (Page 42): Esophageal Perforation In the Mid Esophagus With Mediastinitis In Long-standing Eoe With Stricture Fosupporting

confidence: 59%

Defer No Time, Delays Have Dangerous Ends (William Shakespeare)

Biedermann

Hrúz²

2021

Gastroenterology

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“…Perforation is usually spontaneous and when it occurs after instrumentation it is more commonly associated with the use of rigid endoscopic procedures 36 (2 of 10 rigid endoscopies compared with 0 of 241 with flexible endoscopy), or the push technique of bolus obstruction (five patients). 46 The remainder of perforations were spontaneous. It is important to understand the differences between an EoE perforation from one due to Boerhaave’s syndrome because their treatment and their outcome differ significantly.…”

Section: Complicationsmentioning

confidence: 99%

“…Surgery is required in a minority (30%) and mortality is not reported. 46 Most resolve with conservative treatment of placement of a nasogastric tube, intravenous fluids and prophylactic antibiotics.…”

Section: Complicationsmentioning

confidence: 99%

British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines on the diagnosis and management of eosinophilic oesophagitis in children and adults

Dhar

Haboubi

Attwood

et al. 2022

Gut

121

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BackgroundEosinophilic oesophagitis (EoE) is an increasingly common cause of dysphagia in both children and adults, as well as one of the most prevalent oesophageal diseases with a significant impact on physical health and quality of life. We have provided a single comprehensive guideline for both paediatric and adult gastroenterologists on current best practice for the evaluation and management of EoE.MethodsThe Oesophageal Section of the British Society of Gastroenterology was commissioned by the Clinical Standards Service Committee to develop these guidelines. The Guideline Development Group included adult and paediatric gastroenterologists, surgeons, dietitians, allergists, pathologists and patient representatives. The Population, Intervention, Comparator and Outcomes process was used to generate questions for a systematic review of the evidence. Published evidence was reviewed and updated to June 2021. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was used to assess the evidence and make recommendations. Two rounds of voting were held to assess the level of agreement and the strength of recommendations, with 80% consensus required for acceptance.ResultsFifty-seven statements on EoE presentation, diagnosis, investigation, management and complications were produced with further statements created on areas for future research.ConclusionsThese comprehensive adult and paediatric guidelines of the British Society of Gastroenterology and British Society of Paediatric Gastroenterology, Hepatology and Nutrition are based on evidence and expert consensus from a multidisciplinary group of healthcare professionals, including patient advocates and patient support groups, to help clinicians with the management patients with EoE and its complications.

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“…Additionally, low accuracy of endoscopic diagnosis and resultant diagnostic delay without effective therapeutic intervention carry a higher risk of esophageal stricture, 35 , 36 , 37 impaired quality of life, 38 decreased treatment response, 39 repeated esophageal dilatation, 40 and even critical mechanical injuries, such as perforation. 41 …”

Section: Discussionmentioning

confidence: 99%

Linked color imaging improves the diagnostic accuracy of eosinophilic esophagitis

et al. 2022

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Objectives To assess the usefulness of linked color imaging (LCI), a recently developed image‐enhanced endoscopy technique, in the endoscopic diagnosis of eosinophilic esophagitis (EoE). Methods Thirty white light images (WLIs) and 30 WLI+LCI images collected from patients with and without EoE were randomly and blindly reviewed by 10 endoscopists, including four experts (Exs) and six non‐Exs. Edema, ring, exudate furrows, and strictures were rated on the adjusted EoE endoscopic reference score; the diagnosis of EoE was assessed. Using the kappa value, inter‐ and intra‐observer agreements were analyzed among endoscopists. Results WLI+LCI images had a higher diagnostic accuracy for EoE than WLIs (0.85 vs. 0.70, respectively), especially in non‐Exs or endoscopists with no experience with EoE patients. Inter‐observer agreement for WLI+LCI images statistically surpassed WLIs for furrows (kappa, 0.73 vs. 0.67, respectively; p = 0.0013), stricture (kappa, 0.51 vs. 0.39, respectively; p = 0.0072), and diagnosis (kappa, 0.67 vs. 0.57, respectively; p < 0.0001) of EoE. The increase in inter‐observer agreement in WLI+LCI images allowed for a reduction in the differences between the Exs and non‐Ex endoscopists. Intra‐observer agreement for WLI+LCI images surpassed WLIs for a ring (kappa, 0.62 vs. 0.43, p = 0.0052), and a similar trend was found in exudates, furrows, and diagnosis irrespective of the Exs or non‐Exs. Conclusions LCI can contribute to the improvement of the endoscopic diagnosis for EoE, with “moderate” to “substantial” consistency, by enhancing the visibility of abnormal findings, leading to reduced diagnostic disparities among endoscopists.

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Esophageal perforation in eosinophilic esophagitis: A systematic review on clinical presentation, management and outcomes

Cited by 27 publications

References 78 publications

Defer No Time, Delays Have Dangerous Ends (William Shakespeare)

Defer No Time, Delays Have Dangerous Ends (William Shakespeare)

British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines on the diagnosis and management of eosinophilic oesophagitis in children and adults

Linked color imaging improves the diagnostic accuracy of eosinophilic esophagitis

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