Endoscopic ultrasound (EUS) is an advanced tool increasingly used in upper gastrointestinal endoscopy (EGD) for detailed visualization and diagnosis. This study explored the use of a miniprobe EUS (EUS-MP) with a water-filled latex balloon sheath to assess esophageal remodeling in eosinophilic esophagitis (EoE) patients. EoE, a chronic inflammatory disease causing esophageal wall thickening, is traditionally monitored through symptoms and eosinophil counts, which may not correlate with structural changes. By eliminating the need for free water infusion, the balloon sheath technique enabled efficient and reproducible imaging of esophageal wall layers, including mucosa, submucosa, and total wall thickness (TWT), without compromising measurement accuracy. The study involved 22 patients (16 males, mean age 15 years), including 15 with confirmed EoE and 7 undergoing evaluation for suspected EoE.
Each procedure was performed during routine endoscopy, with EUS measurements taken in both the mid and distal esophagus. A minimum of 12 measurements per patient were completed in less than 10 minutes on average. The water-filled sheath allowed precise imaging by creating a stable acoustic interface without distorting the esophageal wall. This method demonstrated esophageal thickening in patients with active EoE and identified improvements in wall thickness following appropriate treatment. The findings support EUS-MP as a practical, economical, and safe method for assessing esophageal remodeling in EoE and potentially other subepithelial gastrointestinal conditions. This innovative approach could refine the management of EoE by offering a direct, structural assessment of disease progression and therapeutic response, expanding the clinical applications of EUS-MP in gastroenterology.
