Evolution of Endoscopic and Histologic Assessment of Eosinophilic Esophagitis in Europe and Evolution of the Diagnostic Delay: Data From the EUREOS EoE CONNECT Registry
E. Grueso‐Navarro, E. Dilaghi, J. Fernández‐Pacheco, E. Amorena, E. V. Savarino, L. Blas‐Jhon, I. Pérez‐Martínez, A. Granja‐Navacerrada, D. Guagnozzi, L. Martín‐Asenjo, G. Pellegatta, M. Coletta, C. García‐Suárez, S. de la Riva, L. de la Peña‐Negro, E. Betoré, A. L. Krarup, J. Barrio, M. Votto, L. Bujanda, S. Fernández‐Fernández, J. E. Naves, A. González‐Almeida, R. Honrubia‐López, S. Carrión, S. Oliva, C. Caño‐Cerdán, M. L. Masiques‐Mas, S. Espina‐Cadena, J. González‐Cervera, S. Casabona‐Francés, J. Nicolay‐Maneru, V. Úbeda‐Vargas, M. Ghisa, P. Romo‐de Arriba, C. Donado, A. Benagues, V. Martín‐Domínguez, O. Nantes‐Castillejo, L. Arias‐González, D. Maniero, H. Moreira‐González, I. Maray, J. Barrio‐Torres, M. T. Pérez‐Fernández, M. Ostiz‐Llanos, L. Rodríguez‐Alcolado, A. M. Cabrera‐Martínez, E. J. Laserna‐Mendieta, C. Santander, A. J. LucendoABSTRACT
Background
Endoscopy with histopathological assessment of esophageal biopsies is the cornerstone for the diagnosis and phenotypic characterization of eosinophilic esophagitis (EoE).
Objective
To evaluate temporal trends in endoscopic assessment and biopsy sampling practices for EoE in a large European cohort and their association with temporal trends in diagnostic delay (DD).
Methods
A cross‐sectional analysis was conducted using multicenter data from the EoE CONNECT registry. Endoscopic findings and biopsy data at diagnosis were analyzed. Temporal trends in biopsy strategies, EREFS implementation, and DD were assessed. Diagnostic sensitivity of individual esophageal segments and their combinations was evaluated in patients undergoing multi‐segment sampling. Associations between guideline publication and biopsy practices were analyzed using logistic regression models.
Results
A total of 3298 patients were included. Biopsies were obtained from one esophageal segment in 12.6% of patients, two segments in 63.6%, and three segments in 23.8%. Adherence to guideline‐recommended biopsy strategies improved over time, with reduced single‐segment sampling and increased use of ≥ 2 segments. Distal esophageal biopsies provided the highest diagnostic sensitivity, and sampling that included the distal segment achieved sensitivity above 97%, particularly when combined with middle esophageal biopsies. EREFS reporting increased from 88–90% to over 98% in recent years. DD decreased significantly over time (approximately 0.7 years per calendar year), accompanied by a shift from mixed/stricturing to inflammatory phenotypes.
Conclusion
Increased alignment with international guidelines, reflected by standardized endoscopic reporting and multi‐segment biopsy protocols, was associated with improved diagnostic sensitivity, reduced DD, and fewer fibrostricturing presentations.