Diagnosis of Eosinophilic Enteritis Using Double Balloon Enteroscopy-Guided Multisite Biopsies

Area of Science:

• Gastroenterology
• Pathology

Background:

• Eosinophilic enteritis (EoN) is often underdiagnosed due to nonspecific symptoms and challenges in obtaining deep small intestinal biopsies.
• Accurate diagnosis of EoN is crucial for effective patient management.

Purpose of the Study:

• To evaluate the diagnostic utility of double-balloon enteroscopy (DBE)-guided multisite biopsy for diagnosing EoN.
• To identify thresholds for tissue and blood eosinophil counts that differentiate EoN from other conditions.

Main Methods:

• A retrospective cohort study of patients undergoing DBE with small intestinal biopsies.
• Biopsies were collected from up to six predefined small intestinal segments.
• EoN diagnosis was confirmed by biopsy, excluding other causes, and presence of symptoms like abdominal pain or diarrhea.

Main Results:

• DBE-guided multisite biopsy identified significantly higher eosinophil infiltration in EoN patients compared to non-EoN controls (median 77/HPF vs. 23/HPF).
• Peripheral blood eosinophil percentages were markedly elevated in EoN (median 15.2% vs. 1.9%).
• All confirmed EoN cases showed ≥50 eosinophils/HPF in at least one biopsy segment.

Conclusions:

• DBE-guided multisite biopsy is effective for accurate EoN recognition.
• Elevated eosinophil counts in small intestinal biopsies and peripheral blood are key indicators of EoN.
• Further multicenter studies are recommended to establish standardized thresholds and reporting for HPF in EoN diagnosis.