A0198 - Esophageal Cytology Collection Device for Assessment of Esophageal Eosinophilia in Eosinophilic Esophagitis: Real World Experience

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Bryan G. Sauer, MD, MSc

University of Virginia
Charlottesville, VA

Award: Presidential Poster Award

Bryan G. Sauer, MD, MSc¹, Ryan Eid, MD¹, Emily Noonan, BS², Emily McGowan, MD, PhD²
¹University of Virginia, Charlottesville, VA; ²UVA Health, Charlottesville, VA

Introduction: Eosinophilic esophagitis (EoE) is a chronic condition characterized by symptoms of esophageal dysfunction and tissue eosinophilia. One barrier to clinical care in EoE is the need for repeat upper endoscopy (EGD) with biopsies to assess for tissue esophageal eosinophilia. A non-endoscopic esophageal cytology collection device (Cytosponge^TM) may be a viable alternative to assess for esophageal eosinophilia, but few studies have examined its use in EoE.

Methods: We first performed a pilot study in which individuals with confirmed EoE underwent Cytosponge^TM procedure prior to a clinically-indicated EGD. The cytology results were compared to histology obtained via EGD (gold standard). Cytology and histology from mucosal biopsies were classified as active disease (≥1 eos/hpf cytology; ≥15 eos/hpf, respectively) or remission (0 eos/hpf; < 15 eos/hpf, respectively). The eosinophil-associated protein, eosinophil-derived neurotoxin (EDN) was assayed in the supernatant using ELISAs. We subsequently used the Cytosponge^TM to assess for mucosal eosinophils, in place of standard EGD with biopsy, in a subset of patients for clinical care.

Results: For the pilot study, 7 patients (ages 20-53; 57% males) underwent the Cytosponge^TM procedure 1 hour prior to EGD. When using a cut-off of 1 eos/hpf on cytology, there was 100% concordance between the Cytosponge^TM cytology and esophageal biopsies for identifying active EoE and remission (3 active, 4 remission). There was also a trend towards higher concentrations of EDN in the Cytosponge^TM supernatant of active EoE (median 34.11 ng/mL) versus remission (median 9.5 ng/mL, p=0.057). Between September 2020 and May 2022, 15 Cytosponge^TM procedures were performed for clinical care (9 patients; ages 30-61; 56% male). Eight patients were undergoing food elimination diets and one was undergoing surveillance after sustained deep remission. No eosinophilia was seen in 10/15 cytology specimens and 5/15 had eosinophilia (range 1-15 eos)(Table 1). One patient underwent EGD shortly after Cytosponge^TM (1 eos on cytology), which demonstrated 10-30 eos/hpf on mucosal biopsy. The Cytosponge^TM procedure was well-tolerated with no significant adverse events.

Discussion: The Cytosponge^TM is a novel mucosal assessment tool that is easily performed and correlates well with gold standard esophageal biopsies in EoE. It should be considered for use in eosinophilic esophagitis to avoid numerous EGD procedures.

Figure: a) Esophageal cytology collection device (CytospongeTM), b) Histology from standard esophageal biopsy, c) Cytology from CytospongeTM (same patient as b). Arrows point to eosinophils. Note: images previously published in McGowan EC, Aceves SS, CME Review: Noninvasive tests for eosinophilic esophagitis: Ready for use?. Ann Allergy Asthma Immunol 129 (2022); 27-34.

Patient	Age/Sex	Current Treatment	Cytosponge^TM Results	Interpretation
1	61M	Food Elimination Diet - reintroduced soy	0 eos/hpf	Soy is not a trigger
2	50F	Food Elimination Diet - reintroduced dairy	2 eos/hpf	Dairy is a trigger
3a	30F	Food elimination diet - reintroduced soy	0 eos/hpf	Soy is not a trigger
3b		Food elimination diet - reintroduced egg	0 eos/hpf	Egg is not a trigger
3c		Food elimination diet - reintroduced wheat	0 eos/hpf	Wheat is not a trigger
4	44F	Food elimination diet - four food elimination (4FED)	3 eos/hpf	Not in remission on 4FED
5a	40F	Food elimination diet - reintroduced wheat	0 eos/hpf	Wheat is not a trigger
5b		Food elimination diet - reintroduced dairy	1 eos/hpf	Dairy is a trigger
6a	32M	Food elimination diet - two food elimination (2FED)	0 eos/hpf	Remission on 2FED
		Food elimination diet - reintroduced wheat	0 eos/hpf	Wheat is not a trigger
7a	43M	Food elimination diet - reintroduced fish	0 eos/hpf	Fish is not a trigger
		Food elimination diet - reintroduced soy	0 eos/hpf	Soy is not a trigger
8a	39M	Food elimination diet - two food elimination (2FED)	6 eos/hpf	Not in remission on 2FED
		Food elimination diet - four food elimination (4FED)	15 eos/hpf	Not in remission on 4FED
9	36M	Swallowed steroids twice daily and PPI	0 eos/hpf	Maintenance of remission

Table: Esophageal Cytology Collection Device (CytospongeTM) Results in Clinical Use

Disclosures:

Bryan Sauer: Advarra – Advisor or Review Panel Member. Takeda – Consultant.

Ryan Eid indicated no relevant financial relationships.

Emily Noonan indicated no relevant financial relationships.

Emily McGowan: Regeneron Pharmaceuticals – Grant/Research Support.

Bryan G. Sauer, MD, MSc¹, Ryan Eid, MD¹, Emily Noonan, BS², Emily McGowan, MD, PhD². A0198 - Esophageal Cytology Collection Device for Assessment of Esophageal Eosinophilia in Eosinophilic Esophagitis: Real World Experience, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.