A new grading assessment of eosinophilic esophagitis using red dichromatic imaging: A pilot study

Background and Aims The endoscopic reference score (EREFS) using white light imaging (WLI) is used for evaluating the severity of findings objectively in patients with eosinophilic esophagitis (EoE). A novel image-enhanced endoscopy, red dichromatic imaging (RDI) can visualize deeper vessels in the gastrointestinal tract, which could assess edema more precise than WLI. Methods A total of 21 consecutive patients with EoE were prospectively evaluated. Patients were categorized by three grades based on the visibility of vessels with RDI. Clinical features, such as peak eosinophil counts (PEC) and presence of symptoms, were reviewed. Results There were 10 patients with RDI Grade 0/1, and 11 patients with RDI Grade 2. PEC and the prevalence of heartburn were significantly higher in patients with RDI Grade 2 than in patients with RDI Grade 0/1. Conclusions The severity of eosinophilic infiltration could be predicted more precisely using RDI than by evaluating with WLI.