P3922 - Endoscopic Response to Topical Steroids as Measured by the Eosinophilic Esophagitis Endoscopic Reference Score Is Associated With a Need for Fewer Future Esophageal Dilations

Tim S. Gee, BS¹, Sean S. LaFata, BS¹, Hannah L. Thel, BS¹, Brenderia A. Cameron, MS¹, Angela Z. Xue, MD, MPH¹, Akshatha Kiran, MD, MPH², Adolfo A. Ocampo, MD, MA¹, Justin McCallen, MD¹, Christopher J. Lee, MD¹, Stephanie A. Borinsky, MD, MSCR¹, Walker D. Redd, MD¹, Trevor Barlowe, MD¹, Rayan N. Kaataki, MD¹, Cary C. Cotton, MD, MPH¹, Swathi Eluri, MD, MSCR³, Craig C. Reed, MD, MSCR¹, Evan S.. Dellon, MD, MPH, FACG^1
1University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC; ²University of North Carolina at Chapel Hill, Chapel Hill, NC; ³Mayo Clinic, Jacksonville, FL

Introduction: The eosinophilic esophagitis (EoE) Endoscopic Reference Score (EREFS) measures endoscopic severity, and a threshold of ≤2 has been proposed for endoscopic response. It is unknown whether achieving this threshold results in clinically important outcomes. We aimed to determine whether an EREFS response to topical steroids (tCS) is associated with a decreased need for future esophageal dilation.

Methods: We conducted a retrospective cohort study with patients of any age with a new diagnosis of EoE, who underwent esophageal dilation during their index endoscopy, were then treated with tCS, and had at least two follow-up endoscopies: one to assess treatment response and a subsequent procedure. Endoscopic response was defined as EREFS ≤2 (range: 0-9). Histological response was defined as < 15 eos/hpf (≤6 and < 1 eos/hpf also assessed). Global symptom response was recorded. We compared patients with and without endoscopic response, and calculated the number of subsequent dilations in each group. We also calculated time from initial follow-up endoscopy to the subsequent and last procedures on record.

Results: Of 113 EoE patients, 55 (49%) had endoscopic response post-tCS treatment. Compared to endoscopic non-responders, responders were older (43.4 vs 34.4 years; p=0.001), had less esophageal narrowing (29% vs 66%; p< 0.001), and lower EREFS (4.4±1.6 vs. 6.3±1.5; p< 0.001) at baseline (Figure). There were no statistically significant differences in sex, race, BMI, type of tCS used or dose, baseline stricture prevalence, or peak eosinophil count. EREFS responders required fewer dilations on their initial post-treatment endoscopy (65% vs 90%; p=0.002), and had greater symptom (92% vs 64%; p=0.005) and histologic responses at thresholds of < 15 eos/hpf (82% vs 24%; p< 0.001), ≤6 eos/hpf (76% vs 16%; p< 0.001), and < 1 eos/hpf (49% vs 7%; p< 0.001). Over the median follow-up time of 1,106 days (IQR 506-2,068), EREFS responders required fewer dilations than non-responders (4.5±2.9 vs 6.2 ± 4.5; p=0.03), though there were no differences in time to next dilation or last dilation following the initial steroid response endoscopy (Figure).

Discussion: Endoscopic responders to tCS required fewer esophageal dilations compared to non-responders. Responders also had better symptom and histologic responses. These results provide evidence that EREFS and endoscopic response are associated with important clinical outcomes including a reduction in future esophageal dilations.



Disclosures:


Tim S. Gee, BS¹, Sean S. LaFata, BS¹, Hannah L. Thel, BS¹, Brenderia A. Cameron, MS¹, Angela Z. Xue, MD, MPH¹, Akshatha Kiran, MD, MPH², Adolfo A. Ocampo, MD, MA¹, Justin McCallen, MD¹, Christopher J. Lee, MD¹, Stephanie A. Borinsky, MD, MSCR¹, Walker D. Redd, MD¹, Trevor Barlowe, MD¹, Rayan N. Kaataki, MD¹, Cary C. Cotton, MD, MPH¹, Swathi Eluri, MD, MSCR³, Craig C. Reed, MD, MSCR¹, Evan S.. Dellon, MD, MPH, FACG¹. P3922 - Endoscopic Response to Topical Steroids as Measured by the Eosinophilic Esophagitis Endoscopic Reference Score Is Associated With a Need for Fewer Future Esophageal Dilations, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.