Esophageal dilation in eosinophilic esophagitis

Richter, Joel E.

doi:10.1016/j.bpg.2015.06.015

Cited by 31 publications

(22 citation statements)

References 56 publications

(91 reference statements)

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“…For example, many earlier studies reported high incidences of “mucosal tears” or “rents.” 22, 26, 27, 36, 48, 51, 52 The EoE community has since come to a consensus that such findings are an expected and even desired result of successful dilation. 11, 21, 53 Last, our search strategy may have missed important reports of adverse events from the period before eosinophilic esophagitis was widely recognized. Several studies referred to patients with “ringed esophagus,” “stiff or slender esophagus,” or “congenital esophageal stenosis,” which probably described EoE.…”

Section: Discussionmentioning

confidence: 99%

“…The search terms were “eosinophilic esophagitis” combined with “dilation” or “dilatation,” for example in Pubmed: ((*eosinophilic esophagitis) AND (dilation OR dilatation)) OR (*eosinophilic AND (dilation OR dilatation)). Additionally, the reference lists of all of the articles included in the final analysis, as well as previous reviews, 11, 23–25 were hand-searched to ensure identification of all relevant studies. All indexed publications in any language, from January 1, 1950 through June 30, 2016 were eligible for inclusion.…”

Section: Methodsmentioning

confidence: 99%

“…7, 9, 10 In addition, a long duration of symptoms before diagnosis is associated with development of esophageal remodeling. 5, 11–15 In these cases esophageal dilation remains a mainstay of therapy, both with and without concomitant medical therapy. 16–18 …”

Section: Introductionmentioning

confidence: 99%

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Esophageal dilation with either bougie or balloon technique as a treatment for eosinophilic esophagitis: a systematic review and meta-analysis

Dougherty

Runge

Eluri

et al. 2017

Gastrointestinal Endoscopy

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Background and Aims Esophageal dilation is a now recognized to be an important therapeutic modality in eosinophilic esophagitis (EoE). We aimed to evaluate the safety of esophageal dilation in EoE, especially regarding perforation risk, and to examine perforation risk by dilator type. Methods We conducted a systematic review of the published literature from January 1, 1950 to June 30, 2016 using Pubmed, EMBASE, and Web of Science. Studies were included if they described patients with EoE who underwent esophageal dilation and also reported the presence or absence of at least 1 adverse event (eg, perforation, bleeding, pain, or hospitalization). We used random-effects meta-analysis to estimate the frequency of each adverse event. Adverse event rates are listed as percentages with 95% CI throughout. Results Of 923 identified articles, 37 met inclusion criteria and represented 2034 dilations in 977 patients. On meta-analysis, post-procedure hospitalization occurred in 0.689% (0%–1.42%) of dilations, clinically significant GI hemorrhage in 0.028% (0%–0.217%), and clinically significant chest pain in 3.64% (1.73%–5.55%). Nine perforations were documented, a rate of 0.033% (0%– 0.226%) per procedure after meta-analysis. None of the perforations resulted in surgical intervention or mortality. The majority (5/9) were reported before 2009 (rate of 0.41% [0%– 2.75%]); from 2009 forward the rate was 0.030% (0%–0.225%). Dilation method was described in 30 studies (1957 dilations), in which 4 perforations were detected. The estimated perforation rate for bougies was 0.022% (0%–0.347%) and for balloons was 0.059% (0%–0.374%). Conclusions Perforation from esophageal dilation in EoE is rare, and there is no evidence of a significant difference in perforation risk related to dilator type. Esophageal dilation should be considered a safe procedure in EoE.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Esophageal dilation with either bougie or balloon technique as a treatment for eosinophilic esophagitis: a systematic review and meta-analysis

Dougherty

Runge

Eluri

et al. 2017

Gastrointestinal Endoscopy

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“…These results question the significance of histologic response alone in EoE, particularly in those patients with fibrostentotic disease. In the presence of fibrostenosis, esophageal dilatation is required to provide long-lasting improvement of dysphagia despite ongoing mucosal eosinophilia [19][20][21].…”

Section: Discussionmentioning

confidence: 99%

Intrabolus Pressure Has Better Correlation Than Eosinophilia with Dysphagia Severity in Fibrostenotic Eosinophilic Esophagitis: A Pilot Study

Colizzo

Clayton

Kumar

et al. 2018

Gastrointestinal Disorders

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Eosinophilic esophagitis is characterized by dysphagia with esophageal eosinophilia. We sought to determine if intrabolus pressure measurements on high-resolution manometry had any correlation with dysphagia improvement following standard therapy for patients with fibrostenotic eosinophilic esophagitis. Consecutive patients were prospectively enrolled at our swallowing center. Dysphagia scores, esophageal eosinophil counts, endoscopic reference scores, and intrabolus pressure measurements were compared at baseline and following therapy with 8 weeks of a proton-pump inhibitor and serial bougie dilation to a luminal diameter of 17 mm. Five patients were included in the study. The median age was 38 years. The average endoscopic reference score improved from 5.0 to 2.4 (p = 0.007). The mean esophageal diameter improved from 10.8 mm to 17.2 mm (p = 0.001). Dysphagia severity scores improved from a mean value of 34.2 to 10.8 (p = 0.004). Mucosal eosinophilia had no correlation with dysphagia severity. Mean intrabolus pressure improved from 21.8 mmHg to 11 mmHg (p = 0.001). There was strong correlation between a decrease in intrabolus pressure and improvement in dysphagia severity; however, this was not significant (p = 0.108). Intrabolus pressure has strong correlation with dysphagia severity following therapy for fibrostenotic eosinophilic esophagitis. Bougie dilation provides improvement in dysphagia despite persistent mucosal eosinophilia.

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“…[15] This would necessitate multiple dilations to attain a target esophageal diameter of 15 to 18 mm. [13,14,31] …”

Section: Discussionmentioning

confidence: 99%

Role of endoscopic esophageal dilation in managing eosinophilic esophagitis

et al. 2017

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Background:Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disorder of the esophagus characterized by mucosal eosinophilic infiltration. Topical glucocorticoids are considered standard line of treatment, whereas endoscopic dilations are performed for patients presenting with treatment-resistant disease or manifestations of dysphagia and/or food impactions. Efficacy and safety of esophageal dilation in these patients are currently unclear.Aims:Primary outcomes were to evaluate the efficacy, adverse events, and mortality rates of endoscopic esophageal dilation in patients with EoE.Methods: Study Selection Criteria:Studies that reported the use of esophageal dilation in EoE patients were included in this meta-analysis.Data collection and extraction:Articles were searched in Medline, Pubmed, and Ovid journals. Two authors independently searched and extracted data. The study design was written in accordance to PRISMA statement. Clinical improvement was defined as patient-reported symptom relief noted by the authors of individual studies. The symptoms were assessed on various nonstandardized, however, relevant questionnaires that were deemed appropriate by the senior authors of individual studies.Statistical Method:Pooled proportions were calculated using fixed- and random-effects model. I2 statistic was used to assess heterogeneity among studies.Results:Initial search identified 491 reference articles, in which 39 articles were selected and reviewed. Data were extracted from 14 studies (N = 1607) using esophageal dilation for EoE management, which met the inclusion criterion. Mean age of patients was 41years. Pooled patients included 75% males. The pooled proportion of patients that showed clinical improvement with esophageal dilations, after the median follow-up period of 12 months, was 84.95%. No procedure-related deaths were noted. The pooled proportion of patients with post procedural esophageal perforation, chest pain, hospitalization, deep mucosal tear (involving muscularis propria), small mucosal tear, and hemorrhage were 0.61%, 0.06%, 0.74%, 4.04%, 22.32%, and 0.38% respectively. I2 (inconsistency) was 0% (95% confidence interval [CI] = 0–49.8) and Egger: bias was 0.06 (95% CI = −0.30 to 0.42).Conclusions:In patients with conformed diagnosis of EoE, endoscopic esophageal dilation seems to be an effective and safe treatment option. Majority patients with chest pain and deep mucosal tears did not require hospitalization and symptoms were self-limiting

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Esophageal dilation in eosinophilic esophagitis

Cited by 31 publications

References 56 publications

Esophageal dilation with either bougie or balloon technique as a treatment for eosinophilic esophagitis: a systematic review and meta-analysis

Esophageal dilation with either bougie or balloon technique as a treatment for eosinophilic esophagitis: a systematic review and meta-analysis

Intrabolus Pressure Has Better Correlation Than Eosinophilia with Dysphagia Severity in Fibrostenotic Eosinophilic Esophagitis: A Pilot Study

Role of endoscopic esophageal dilation in managing eosinophilic esophagitis

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