ASGE consensus recommendations on the endoscopic management of eosinophilic esophagitis — part 2: disease assessment, monitoring, and pediatric considerations - 08/01/26

Doi : 10.1016/j.gie.2025.10.032

Evan S. Dellon, MD, MPH ^1,^{^{∗
Drs Dellon and Sharma are co-chairs.}}^{^{†
Drs Dellon, Falk, Katzka, Lightdale, Muir, and Sharma are core group members.},}^⁎ , Gary W. Falk, MD, MS, MASGE ^2,^{^{†
Drs Dellon, Falk, Katzka, Lightdale, Muir, and Sharma are core group members.}}, David A. Katzka, MD ^3,^{^{†
Drs Dellon, Falk, Katzka, Lightdale, Muir, and Sharma are core group members.}}, Jenifer Lightdale, MD, MPH ^4,^{^{†
Drs Dellon, Falk, Katzka, Lightdale, Muir, and Sharma are core group members.}}, Amanda B. Muir, MD ^5,^{^{†
Drs Dellon, Falk, Katzka, Lightdale, Muir, and Sharma are core group members.}}, Albert J. Bredenoord, MD, PhD ⁶, Dominique D. Bailey, MD, MSEd ⁷, Joy W. Chang, MD, MS ⁸, Glenn T. Furuta, MD ⁹, Nirmala Gonsalves, MD ¹⁰, Thomas Greuter, MD ¹¹, Sandeep K. Gupta, MD ¹², Girish Hiremath, MD, MPH ¹³, Jennifer L. Horsley-Silva, MD ¹⁴, Alfredo J. Lucendo, MD, PhD ¹⁵, Kristle L. Lynch, MD ¹⁶, Calies Menard-Katcher, MD ¹⁷, Fouad Moawad, MD ¹⁸, Salvatore Oliva, MD, PhD ¹⁹, Kathryn A. Peterson, MD ²⁰, Hamish Philpott, MD ²¹, Philip E. Putnam, MD ²², Alain M. Schoepfer, MD ²³, Diana L. Snyder, MD ²⁴, Alex Straumann, MD ²⁵, Josh B. Wechsler, MD, MSCI ²⁶, Prateek Sharma, MD ^27,^{^{∗
Drs Dellon and Sharma are co-chairs.},}^{^{†
Drs Dellon, Falk, Katzka, Lightdale, Muir, and Sharma are core group members.}}

¹ Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA

² Division of Gastroenterology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA

³ Division of Gastroenterology and Hepatology, Columbia University, New York, New York, USA

⁴ Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA

⁵ Division of Pediatric Gastroenterology, Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA

⁶ Department of Gastroenterology, Amsterdam University Medical Center, Amsterdam, the Netherlands

⁷ Division Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA

⁸ Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA

⁹ Gastrointestinal Eosinophilic Diseases Program, Department of Pediatrics, University of Colorado School of Medicine, Section of Pediatric Gastroenterology and Hepatology, Children's Hospital Colorado, Aurora, Colorado, USA

¹⁰ Division of Gastroenterology & Hepatology, Northwestern University – Feinberg School of Medicine, Chicago, Illinois, USA

¹¹ Division of Gastroenterology and Hepatology, EOC Lugano, Università della Svizzera italiana, Lugano, Switzerland

¹² Division of Pediatric Gastroenterology, University of Alabama at Birmingham/Children's of Alabama, Birmingham, Alabama, USA

¹³ Division of Pediatric Gastroenterology, Department of Pediatrics, Monroe Carrell Jr Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, USA

¹⁴ Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, Arizona, USA

¹⁵ Department of Gastroenterology, Hospital General de Tomelloso, Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Instituto de Investigación Sanitaria Princesa, Madrid, Spain

¹⁶ Division of Gastroenterology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA

¹⁷ Section of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Digestive Health Institute, Children's Hospital Colorado, Aurora, Colorado, USA

¹⁸ Division of Gastroenterology, Scripps Clinic, La Jolla, California, USA

¹⁹ Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, University Hospital - Umberto I, Sapienza - University of Rome, Rome, Italy

²⁰ Division of Gastroenterology, Department of Medicine, University of Utah, Salt Lake City, Utah, USA

²¹ Department of Gastroenterology NALHN, University of Adelaide, Adelaide, South Australia

²² Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio, USA

²³ Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland

²⁴ Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA

²⁵ Department of Gastroenterology University Hospital Zurich, Zurich, Switzerland

²⁶ Division of Gastroenterology, Hepatology & Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA

²⁷ VA Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA

^∗ Corresponding author: Evan S. Dellon, MD, MPH, Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA. American Society for Gastrointestinal Endoscopy 3300 Woodcreek Drive Downers Grove Illinois 60515 USA

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 08 January 2026

Abstract

Esophagogastroduodenoscopy is essential to evaluate symptoms of suspected eosinophilic esophagitis (EoE), assess endoscopic findings, obtain biopsy specimens for histopathologic evaluation, perform esophageal dilation, confirm the diagnosis, and monitor the condition. The American Society for Gastrointestinal Endoscopy (ASGE) previously provided consensus recommendations on the approach to endoscopy in EoE across topics of endoscopic diagnosis, endoscopic grading, and esophageal dilation. Because additional areas of endoscopy still required guidance, we performed an independent modified Delphi process focusing on pediatric considerations, disease assessment, and disease monitoring. A core group of EoE experts reviewed published guidelines and developed a set of patient-centered recommendation statements informed by literature review. A multidisciplinary group of adult and pediatric international EoE experts then voted on the statements over 2 Delphi rounds. All statements with 80% agreement were accepted for inclusion. This process yielded 28 consensus statements. Pediatric-specific statements covered when to suspect EoE and perform endoscopy, how to grade endoscopic severity, and when and how to perform esophageal dilation in children. Statements across all age ranges addressed the role of less-invasive monitoring, performing diagnostic endoscopy off treatment, the need to consider symptoms, endoscopic features, and histologic findings when assessing disease activity, treatment-based monitoring intervals, and the approach to esophageal biopsies during monitoring. Coupled with the original consensus work, we provide a comprehensive endoscopic approach to EoE as well as practical guidance for procedure-related aspects in the field to facilitate high-quality endoscopic care to patients with EoE.

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Abbreviations : ASGE, EGD, EGIDs, EoE, EREFS, EST, GERD, I-SEE, MBP, PPIs, uTNE