Eosinophilic esophagitis (EoE) is a chronic, slowly progressive immune-mediated esophageal disease. Upper endoscopy (EGD) with biopsy and subsequent histology is a decisive method for the diagnosis.

OBJECTIVE

To determine the positive predictive value of outpatient EGD in the diagnosis of pediatric EoE.

MATERIALS AND METHODS

During the period 2016—2021, EGD revealed endoscopic signs of EoE in 104 patients (128 procedures). All of them underwent an esophageal mucosa biopsy for histology examination. In 93.3% of cases, EGD was performed under local anesthesia in outpatient clinics. The study evaluated the positive predictive value of endoscopic signs of EoE in comparison with histological verification of the diagnosis.

RESULTS

Specific whitish exudate and longitudinal furrows were the most frequent endoscopic signs that motivated the examinator to perform a biopsy. In 35 (33.6%) children — 31 males (89%), 4 girls (11%); mean age, 13±3.5 years—the diagnosis was histologically confirmed. 7 (20%) of them required several EGDs to confirm EoE. With an increase in the number of biopsies to 3, the probability of diagnosis verification increased by 3.2 times. However, only 2.3% (3) of patients underwent multiple biopsies due to unfavorable reactions to EGD with local anesthesia. The detection of EoE has increased over the 5-year study period.

CONCLUSIONS

Outpatient EGD with local anesthesia had a 33.6% positive predictive value for the diagnosis of pediatric EoE. Non-specific endoscopic signs, focal spreading of inflammation in the esophagus, and the most important, the complexity of performing multiple biopsies during EGD without sedation, lead to late diagnosis in children.