Examining Lamina Propria Procurement with Various Combinations of Endoscopic Biopsy Sampling Techniques in Pediatric Eosinophilic Esophagitis Patients

This study focuses on eoe, a chronic inflammatory disease that can lead to fibrotic remodeling of the esophagus. in order to evaluate for early fibrosis, an esophageal biopsy that procures adequate subepithelium, or LP, is needed. The goal of this study is to evaluate the LP procurement rate of various combinations of standard endoscopic esophageal biopsy sampling techniques. This study will be divided into 4 parts. in Part i, we will determine the superiority of the combination of Perpendicular-Suction-Single Pinch techniques over the Tangential-no Suction-Double Pinch techniques. For each subject, the Study endoscopist will collect half of the clinical biopsies using one combination and half of the clinical biopsies using the other. in Part ii, we will determine the non-inferiority of the combination of Tangential-Suction-Single Pinch techniques from the Perpendicular-Suction-Single Pinch techniques. For each subject, the Study endoscopist will collect half of the clinical biopsies using one combination and half of the clinical biopsies using the other. in Part iii, we will determine the non-inferiority of the combination of Perpendicular-Suction-Double Pinch techniques from the Perpendicular-Suction-Single Pinch techniques. For each subject, the Study endoscopist will collect half of the clinical biopsies using one combination and half of the clinical biopsies using the other. in Part iV, we will determine the non-inferiority of the combination of Perpendicular-no Suction-Single Pinch techniques from the Perpendicular-Suction-Single Pinch techniques. For each subject, the Study endoscopist will collect half of the clinical biopsies using one combination and half of the clinical biopsies using the other. Study Pathologists blinded to the techniques will grade the quality of the biopsy samples on the following: fragmentation of the samples, presence or absence of adequate LP, the presence or absence of fibrosis, and the peak intraepithelial eosinophil count.