Eosinophilic esophagitis (EoE) is a chronic, immune-mediated esophageal disease increasingly encountered by surgeons across foregut practice, presenting as dysphagia, food bolus impaction, and fibro stenotic strictures. Although medical and dietary therapies are first-line, surgeons play a critical role in perioperative recognition, obtaining diagnostic biopsies at the index endoscopy, and endoscopic management. This clinically focused review highlights clinical cues for EoE, best practices for endoscopy and biopsies, pathophysiology, and operative planning considerations, and evolving treatment paradigms. Durable outcomes require multidisciplinary coordination to optimize inflammation, prevent recurrent fibro stenosis, and avoid inappropriate operations or reoperations.
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