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Outcomes of Esophageal Dilation in Eosinophilic Esophagitis: Safety, Efficacy, and Persistence of the Fibrostenotic Phenotype

Runge, Thomas M MD, MPH1; Eluri, Swathi MD1; Cotton, Cary C MPH1; Burk, Caitlin M BA1; Woosley, John T MD, PhD2; Shaheen, Nicholas J MD, MPH1,3; Dellon, Evan S MD, MPH1,3

American Journal of Gastroenterology: February 2016 - Volume 111 - Issue 2 - p 206–213
doi: 10.1038/ajg.2015.399
ORIGINAL CONTRIBUTIONS: ESOPHAGUS
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Objectives: Esophageal dilation is commonly performed in eosinophilic esophagitis (EoE), but there are few long-term data. The aims of this study were to assess the safety and long-term efficacy of esophageal dilation in a large cohort of EoE cases, and to determine the frequency and predictors of requiring multiple dilations.

Methods: We conducted a retrospective cohort study in the University of North Carolina EoE Clinicopathological Database from 2002 to 2014. Included subjects met consensus diagnostic criteria for EoE. Clinical, endoscopic, and histologic features were extracted, as were dilation characteristics (dilator type, change in esophageal caliber, and total number of dilations) and complications. Patients with EoE who had undergone dilation were compared with those who did not and also stratified by whether they required single or multiple dilations.

Results: Of 509 EoE patients, 164 were dilated a total of 486 times. Those who underwent dilation had a longer duration of symptoms before diagnosis (11.1 vs. 5.4 years,P<0.001). Ninety-five patients (58%) required >1 dilation (417 dilations total, mean of 4.4±4.3 per patient). The only predictor of requiring multiple dilations was a smaller baseline esophageal diameter. Dilation was tolerated well, with no major bleeds, perforations, or deaths. The overall complication rate was 5%, primarily due to post-procedural pain. Of 164 individuals dilated, a majority (58% or 95/164) required a second dilation. Of these individuals, 75% required repeat dilation within 1 year.

Conclusions: Dilation in EoE is well-tolerated, with a very low risk of serious complications. Patients with long-standing symptoms before diagnosis are likely to require dilation. More than half of those dilated will require multiple dilations, often needing a second procedure within 1 year. These findings can be used to counsel patients with fibrostenotic complications of EoE.

1Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA

2Department of Pathology and Laboratory Medicine; University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA

3Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA

Correspondence: Evan S. Dellon, MD, MPH, Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, CB#7080, Bioinformatics Building, 130 Mason Farm Road, Chapel Hill, North Carolina 27599-7080, USA. E-mail: edellon@med.unc.edu

SUPPLEMENTARY MATERIAL accompanies this paper at http://links.lww.com/AJG/A416

Received 01 August 2015; accepted 01 November 2015

Guarantor of the article: Evan S. Dellon, MD, MPH.

Specific author contributions: Data collection, data analysis and interpretation, manuscript drafting, and critical revision: Thomas M. Runge; data collection and interpretation, and critical revision: Swathi Eluri, Cary C. Cotton, and Caitlin M. Burke; pathology supervision, data collection, and critical revision: John T. Woosley; project supervision, data interpretation, and critical revision: Nicholas J. Shaheen; project conception and supervision, data collection and interpretation, manuscript drafting, and critical revision: Evan S. Dellon; all authors approved the final draft.

Financial support: This research was conducted with support from NIH awards T32DK007634 (T.M.R.), K23DK090073 (E.S.D.), K24DK100548 (N.J.S.), and R01DK101856 (E.S.D.).

Competing interests: None.

© The American College of Gastroenterology 2016. All Rights Reserved.
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