Aims
To systematically review and meta-analyze the diagnostic accuracy of EST compared to endoscopic biopsy for diagnosing active EoE.
Methods
We conducted a systematic search of PubMed, Embase, and Web of Science (through November 2025) for studies evaluating EST against biopsy as the reference standard in EoE diagnosis. A total of 449 studies were found, deduplicated and of the 5 full-text articles assessed, 2 studies met inclusion criteria (Furuta et al. 2013; Ackerman et al. 2019), comprising 175 total participants.
Results
Both studies demonstrated high AUCs (0.82–0.97) and strong correlations between EST biomarkers and esophageal eosinophil counts. However, neither study reported diagnostic thresholds, binary classifications, sensitivity/specificity, or ROC coordinates. Because EST biomarkers were analyzed as continuous measures without predefined cutoffs, no 2×2 contingency tables could be constructed, and meta-analysis of pooled sensitivity and specificity was not feasible.
| Author, Year | Population (N) | Age | Disease Activity Groups | AUROC / AUC | Key Biomarkers (Correlation r) | Biomarker Findings | Patient Preference |
|---|
| Furuta GT, 2023 | 41 | 7–20 yrs | Active 14 / Inactive 8 / Normal 19 | 0.97 | MBP-1 (0.72), EDN (0.48), ECP (0.21), EPX (0.54), CLC/Gal-10 (0.73) | All eosinophil-derived proteins significantly elevated in active EoE | – |
| Ackerman, 2019 | 134 | Active 24.9±13.8; Inactive 29.3±17.1; Normal 17.1±9.7 | Active 62 / Inactive 37 / Normal 35 | 0.82–0.87 | Eot-3 (0.73), Eot-2 (0.60), EPX (0.49), MBP-1 (0.46), EDN (0.45), CLC (0.36) | All biomarkers significantly elevated in active EoE | 87% children; 95% parents; 92% adults preferred EST |
Conclusions
EST shows promise as a minimally invasive tool for monitoring EoE activity, with high AUC values and excellent patient acceptability. However, the absence of standardized diagnostic thresholds and insufficient statistical reporting precludes evidence synthesis of diagnostic accuracy. Future studies must establish and validate pre-specified EST cutoffs with complete 2×2 tables to determine clinical utility. Until then, EST cannot be recommended as a replacement for endoscopic biopsy in diagnostic pathways.