Variability in time to surveillance endoscopy for eosinophilic esophagitis remission and relation to treatment outcomes.

Patients with eosinophilic esophagitis (EoE) in remission require monitoring, but optimal timing for endoscopic assessment is unknown. We aimed to assess variability in time from remission to surveillance endoscopy and associations with disease outcomes. This retrospective cohort study included patients with EoE who achieved histologic remission (<15 eos/hpf) while on stable treatment and had at least one surveillance endoscopy with biopsy after remission. Time to surveillance was categorized (≤1 year, 1-2 years, >2 years) and compared to a range of EoE clinicopathologic characteristics and disease outcomes. The 91-patient cohort had substantial variability in time to first surveillance endoscopy (mean 1.3 ± 1.0 years; median/IQR 1.0/0.6-1.8; range 0.2-7.3). While most patient characteristics were not associated with time to surveillance, larger dilation size at remission correlated with longer surveillance intervals (R = 0.36, p = 0.03), and EoE Endoscopic Reference Score (EREFS) was inversely associated (R = -0.21, p = 0.07). Outcomes of EREFS, Index of Severity of EoE, and eosinophil count were similar for <1, 1-2, or 2+ years surveillance intervals. However, numerically fewer patients with endoscopy 2+ years after remission maintained histologic response (59% vs. 78% at ≤1 year and 82% at 1-2 years; p = 0.15) and had more ongoing EoE symptoms (47% vs. 34% at ≤1 year and 24% at 1-2 years; p = 0.26). Surveillance timing in EoE remission varies widely and is largely unexplained by clinical features, except for dilation size. While outcomes were similar across intervals, patients with longer surveillance (>2 years) had numerically less histologic response and more persistent symptoms, warranting further study.