Secondary Logo

Institutional members access full text with Ovid®

Esophageal dilation in eosinophilic esophagitis: risks, benefits, and when to do it

Lucendo, Alfredo, J.a,b; Molina-Infante, Javierb,c

Current Opinion in Gastroenterology: July 2018 - Volume 34 - Issue 4 - p 226–232
doi: 10.1097/MOG.0000000000000442
ESOPHAGUS: Edited by Stuart J. Spechler
Buy
SDC

Purpose of review For patients with eosinophilic esophagitis (EoE), endoscopic dilation has been used primarily to provide immediate symptomatic relief of dysphagia. This report reviews the current position of esophageal dilation in the therapeutic algorithm for EoE, including effectiveness and safety issues.

Recent findings Esophageal strictures in EoE develop as a consequence of long-lasting esophageal eosinophilia, with patient age and diagnostic delay as well established risk factors. Endoscopic dilation leads to immediate symptomatic improvement in 95% of EoE patients who have strictures or narrow caliber esophagus. As dilation has no effect on the underlying eosinophil inflammation, repeated procedures are usually needed to maintain symptoms in remission. Adding an effective drug or dietary-based EoE therapy reduces the need of further dilation. The high rate of severe complications from dilation reported in early literature has not been reproduced in most recent series, with mild postprocedural chest pain as the most common side effect. Current data suggest that the risk of esophageal perforation is less than 1%. Mucosal tears after dilation should no longer be considered a complication, but rather a marker of procedural success.

Summary Esophageal dilation should be considered in EoE patients with esophageal strictures or narrow caliber esophagus who have persistent dysphagia/food impaction despite an effective anti-inflammatory treatment.

aDepartment of Gastroenterology, Hospital General de Tomelloso, Tomelloso

bCentro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid

cDepartment of Gastroenterology, Hospital San Pedro de Alcántara, Cáceres, Spain

Correspondence to Alfredo J. Lucendo, MD, PhD, FEBGH, Department of Gastroenterology, Hospital General de Tomelloso, Servicio de Salud de Castilla-La Mancha, Vereda de Socuéllamos, s/n, 13700 Tomelloso, Spain. Tel: +34 926 525 927; fax: +34 926 525 870; e-mail: ajlucendo@hotmail.com

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.