Hirano et al developed a classification and grading system for eosinophilic esophagitis based on endoscopic changes. The authors are from Northwestern University.
(1) fixed rings (trachealisation, circumferential ridges, concentric rings, corrugated rings)
(2) exudates (plaques, white spots)
(3) furrows (longitudinal furrows, vertical lines)
(4) edema (mucosal pallor, decreased vascular markings)
(1) crepe paper esophagus (mucosal fragility, laceration with passage of endoscope)
severe (unable to pass endoscope)
< 10% of surface area
>= 10% of surface area (severe)
crepe paper esophagus
• Two additional minor features were removed due to poor interobserver agreement. One was narrow caliber esophagus and the second feline esophagus (transient rings).
• An original grading system was reduced in complexity to improve interobserver agreement.
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