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There is limited understanding of the aetiology, disease progression and prognosis of children with EoE. One hypothesis suggests that intestinal epithelial barrier impairment leads to eosinophil activation and migration into the oesophagus. Repeat endoscopies are required to monitor treatment response.As part of the BioEvocs study, we assessed the feasibility to collect stool samples in children with EoE compared to controls for subsequent analysis of the gut metabolome and microbiome.The aim was to enrol 60 patients with EoE (EOB for baseline and EOF follow-up), 30 with non-EoE oesophageal controls (OCB), and 30 normal (NCB)controls (for baseline) in 4 UK sites over a 12-month period. Following informed consent, patients were invited to bring in stool samples to clinic, endoscopy appointment, or within a month of baseline visit or follow-up endoscopy. Samples were stored in freezer, freezer-fridge, fridge or for limited room temperature until storage at -80C at study centres. Patients and parents were asked to complete clinical (CRF), oesophageal symptoms (PEESS) and nutritional (NUT) questionnaires, endoscopy and histology data were collected, and samples stored for subsequent metabolome and microbiome analysis.Due to post-COVID and logistic restrictions, recruitment period was limited to 9.5 months (ending September 2025) and increasing hospital waiting lists, reduced face-to-face clinic appointments, cost-of-living, willingness to undergo repeat endoscopies, and availability of endoscopy lists, patients were included for the study if their disease-related medication/diet was reported unchanged since their previous endoscopy, whereas NCB patients were recruited from routine ophthalmology clinics.Median time interval from endoscopy date to stool sample was mean 53d (SD 75d), for EOB, 19d (SD 25.5d) for EOF, 318.5d (SD 405d) for OEB and 1d (SD 0d) for NCB patients.These results suggest that collection of stool samples in patients with EoE and non-EoE clinical conditions is feasible, when appointments were scheduled and coordinated by clinical and research staff. Under research conditions requiring informed consent, and delivery of stool samples in person to the tertiary hospital, collection of stool samples with clinical questionnaires was feasible in nearly all normal control patients with a clinic visit upcoming, and in half of EoE and a third of oesophageal control patients who required correlation with baseline and follow-up endoscopy and histology data. In clinical setting, patients with EoE may require additional information at time of diagnosis and follow-up to signpost and motivate them for the potential use of stool samples as biomarker for surveillance in EoE.BSPGHAN/GutsUK/Dr Falk sponsored BioEvocs.Abstract OC57 Table 1Feasibility of collecting stool samples in EoE patients and controlsEoE baselinen and %EoE follow-upn and %Oesophageal controlsn and %Normal controlsn and %Approachedn=71n=70n=69n=78Consentedn=54n=51n=32n=31Completed correctlyn=23/44, (52.3%)n=27/51 (52.9%)n=9/30 (30%)n=30/31 (97%)Failed CRF/PEESSn=1 (1.9%)n=3 (5.8%)n=1 (3%)0Failed stool samplen=3 (5.5%)n=8 (15.6%)n=2 (6.7%)0Patient withdrewn=2 (3.7%)000Logistic reasonsn=1 (1.9%)n=3 (5.8%)0n=1 (3%)Total withdrawn=7 (12.9%)n=4 (12.9%)n=1 (0.3%)n=1 (0.3%)