Endoscopic Management of Eosinophilic Esophagitis: A Narrative Review on Diagnosis and Treatment

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease characterized by esophageal eosinophilic infiltration, leading to symptoms such as dysphagia and food impaction. Endoscopy is central to both diagnosis and management, allowing for the direct visualization of characteristic features, biopsy collection, and therapeutic interventions. Despite its diagnostic value, up to one-third of patients may present with a normal-appearing esophagus, highlighting the importance of standardized scoring systems and a systematic biopsy approach. This review explores the evolving role of endoscopy in EoE, from traditional diagnostic methods to emerging technologies such as EndoFlip™ for assessing esophageal distensibility, transnasal endoscopy for non-sedated monitoring, and novel dilation techniques for fibrostenotic disease. Additionally, non-invasive biomarkers and minimally invasive tools are reshaping disease monitoring. By integrating endoscopic, histologic, and molecular approaches, future advancements may enhance diagnostic accuracy and optimize personalized treatment strategies for EoE.