Severe Dysphagia in Children With Eosinophilic Esophagitis and Esophageal Stricture: An Indication for Balloon Dilation?

Abstract

In our pediatric series, combined medical (corticosteroids, elemental diet, and food elimination diet) and endoscopic approach (repeated balloon dilation) were effective and safe in patients with severe EoE and esophageal stricture.

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

“…Subgroup analyses revealed possible trends toward different adverse event rates by publication period, maximum dilator size, and pediatric versus adult studies, although none of these differences reached statistical significance (Supplemental Tables 5–7). For instance, the point estimates of frequency of perforation (0.0%; 95% CI, 0%–1.88%), clinically significant chest pain (2.19%; 95% CI, 0%–5.65%), and any chest discomfort (10.2%; 95% CI, 0%–23.2%) were lower for pediatric than for adult studies, although only 2 to 3 studies contributed to each of these pediatric estimates 28, 29, 36 Perforation rate with larger dilators (>17 mm) was 1.35% (95% CI, 0%–8.43%) versus 0.03% (95% CI, 0%–0.226%) for smaller dilators, hospitalization 4.02% (95% CI, 0%–16.6%) versus 0.511% (95% CI, 0%–1.08%), and clinically significant chest pain 7.14% (95% CI, 0%–19.8%) versus 4.46% (95% CI, 1.41%–7.50%). Finally, the meta-analysis confirmed the direction of association between studies published before 2009 with higher perforation rates, estimating a 0.41% (95% CI, 0%–2.75%) rate before 2009 compared with 0.030% (95% CI, 0%–0.225%) in more recent studies.…”

“…Three studies contributed the majority of dilation procedures (1232 dilations on 532 patients), 12, 13, 27 whereas 18 studies described single-digit numbers of dilated patients, totaling 86 dilation procedures (Table 1). Of the studies with more than one subject, three focused on pediatric patients, 28, 29, 36 2 3 were restricted to adults, 2 had both adults and children, 12, 13 and in one, abstract age was not reported. 37 The follow-up periods of the individual studies ranged from 1 week to 14 years (median 14.7 months).…”

“…“Hospitalization” was observed after 19 of 1814 dilations, excluding 2 pediatric studies where all patients were hospitalized overnight per protocol 29, 36 (Table 2). Significant GI bleeding postprocedure was extremely rare, after only 1 out of 1806 dilations.…”

“…It may also be beneficial to pair dilation with a medical or dietary anti-inflammatory intervention, as dilation does not affect esophageal eosinophilia, 13, 50 and repeat dilations are needed more frequently if inflammation is not controlled. 12, 15, 36 …”

“…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.…”