# Utilizing a balloon sheath and miniprobe for diagnostic endoscopic ultrasound in eosinophilic esophagitis: a case series

## TL;DR

A new technique using a balloon sheath and miniprobe allows quick imaging of the esophageal wall in patients with eosinophilic esophagitis.

## Contribution

The study introduces a modified EUS technique using a balloon sheath and miniprobe for rapid and reproducible imaging of the esophageal wall.

## Key findings

- The technique enabled full esophageal wall measurements in 22 EoE patients within an average of 10 minutes.
- The method is described as economical, convenient, and safe for monitoring EoE patients.
- The approach may be applicable to other patients with subepithelial gastrointestinal pathology.

## Abstract

Endoscopic ultrasound (EUS) is a unique example of POCUS, which allows the gastroenterologist to discuss subepithelial pathology immediately after an endoscopy. The challenges that are encountered to create an acoustic interface by adding free water during the endoscopy may be curtailing the full utilization of EUS during endoscopic procedures. Eosinophilic esophagitis (EoE) is a progressive inflammatory condition whose morbidity is related to esophageal wall remodeling. However, in clinical practice, in clinical guidelines, and in many trials, EoE outcomes are based on esophageal eosinophilia and symptoms. Hence, a method to identify and quantitate the thickening of the esophageal wall, could contribute to the management of this disease.

A modification of the approach employed to perform EUS during bronchoscopy was developed. An EUS miniprobe was positioned inside of a water filled balloon sheath. This technique permitted rapid and reproducible images acquisition of the total esophageal wall and its sublayers (mucosa, and submucosa + submucosa, which permitted derivation of the muscle layer). The presented series describes the results from  22 consecutive EoE patients. A full set of measurements from both the mid and distal esophagus were achieved in all EoE patients in an average time of less than 10 minutes.

This pilot study supports further investigations evaluating this economical, convenient, and safe technique to follow EoE patients. In addition, this approach could be potentially employed in all patients who are found to have subepithelial gastrointestinal pathology during routine endoscopic procedures.

The online version contains supplementary material available at 10.1186/s13089-024-00380-7.