Endoscopic Features of Eosinophilic Esophagitis: From Its Origins to Current Practice and Innovations. Literature Review and Personal Experience

Aim: to systematize literature data and the authors’ own findings regarding the endoscopic features of eosinophilic esophagitis.

Key points. Eosinophilic esophagitis is a chronic inflammatory disease of the esophagus characterized by marked eosinophilic infiltration of the esophageal mucosa, as well as subepithelial and submucosal fibrosis. These changes lead to functional impairment of the esophagus, stricture formation, and luminal narrowing, clinically manifesting as progressive dysphagia and episodes of luminal obstruction by a food bolus. Timely diagnosis and appropriate treatment of eosinophilic esophagitis help prevent the development of strictures and other complications.

The diagnosis relies on endoscopic evaluation with the procurement of multiple biopsies (at least six) from the esophageal mucosa to confirm a characteristic histological picture. The main and additional endoscopic findings in eosinophilic esophagitis include edema, linear furrows, rings, exudates, strictures, so-called “feline” esophagus, narrow-caliber esophagus, and the “crepe-paper” esophagus. In recent years, new endoscopic signs have been proposed, such as multiple polypoid lesions, esophageal changes resembling “ankylosaur back” and a “caterpillar track” pattern. Despite the range of possible endoscopic findings, they exhibit relatively low specificity and may be overlooked by endoscopists, leading to delayed diagnosis. High-resolution endoscopic equipment and the development of artificial intelligence programs for image processing hold promise in improving diagnostic accuracy.

Conclusion. Esophagogastroduodenoscopy is the key method for diagnosing eosinophilic esophagitis: awareness of the disease’s endoscopic signs and taking multiple biopsies from the esophagus when eosinophilic esophagitis is suspected allow early diagnosis — prior to the onset of complications — thereby enabling timely treatment to prevent stricture formation.

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