Utilization and impact of esophageal string testing in children with eosinophilic esophagitis: A 1 year experience

The 1-h esophageal string test (EST) is a minimally invasive test that can be used to monitor eosinophilic esophagitis (EoE) disease activity and guide treatment without endoscopy. We aimed to describe the real-world utilization and impact of EST on the care of children with EoE over the first year this was used at our center. Between 12/1/2022 and 11/30/2023, 39 ESTs were successful in 45 attempts (87% completion rate) in 31 patients. Five patients underwent multiple ESTs. Adverse events during the EST included vomiting. Reasons for failure to complete the EST (13%, n = 6) were patients could not swallow the capsule (n = 5) and vomiting (n = 1). EST was used to assess EoE without the need for endoscopy in 95% (n = 37) of cases. Treatment approach varied based on whether the EST indicated active (38.5%) or inactive (61.5%) EoE. The EST is a well-tolerated minimally invasive disease monitoring tool for patients with EoE. What is Known The esophageal string test (EST) is a non-endoscopic minimally invasive test developed to monitor disease activity in patients with eosinophilic esophagitis (EoE). Eosinophil-associated protein levels measured with the EST correlate with tissue biopsy peak eosinophil counts and can distinguish between active and inactive EoE.What is New In the first year of utilizing the EST by a multidisciplinary EoE clinic, 31 patients with EoE ages 6-20 years old underwent EST with an 87% success rate. EST was safe, efficient, well-tolerated, and a lower cost alternative than conventional endoscopy. In a clinical setting, EST results led to management changes of EoE without the use of conventional endoscopy.